Alzheimer's
Foundation of America

I agree to participate in a Therapeutic Recreation group hosted by the Alzheimer’s Foundation of America, Inc. (“Alzheimer’s Foundation of America”) and facilitated by a Recreational Therapist employed or engaged by the Alzheimer’s Foundation of America.

I understand that the purpose of this Therapeutic Recreation group is to provide a forum for participants to connect with one another, and promote physical, emotional, social, and cognitive engagement with the hope of improving overall health and well-being.

I agree, if I engage in any physical exercise or activity upon entering Alzheimer’s Foundation of America’s premises or use any facility or equipment on the premises for any purpose, I do so at my own risk and assume the risk of any and all injury and/or damage that may occur, whether while engaging in physical exercise or not. This includes injury or damage sustained while and/or resulting from exercise, activity or using any equipment. If I have any doubt as to my ability to successfully and safely participate in any exercise or activity, I take full responsibility for consulting a physician.

I understand, the Alzheimer’s Foundation of America cannot prevent me or my family from becoming exposed to, contracting, or spreading COVID-19, while participating in therapeutic programs on the Alzheimer’s Foundation of America’s premises. By attending therapeutic programs at The Alzheimer’s Foundation of America, I understand the risk of exposing myself to and/or increasing risk of contracting or spreading COVID-19. With this understanding, I hereby forever release and waive my right to sue The Alzheimer’s Foundation of America, and its owners, officers, directors, managers, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to my attendance of their therapeutic program.

I understand that the Therapeutic Recreation group is confidential, except as mandated by law. In certain situations, Alzheimer’s Foundation of America is required by law to reveal information obtained during group sessions to other persons or agencies without my consent. These situations include cases of suspected abuse/neglect of children or the elderly; and cases of potential harm to self or others.

I understand that this group does not take the place of consultation with a physician or other healthcare professional on any issues related to my health and/or formal mental health or substance abuse treatment, and agree to seek assessment and treatment for mental health/substance abuse or other issues by an appropriate clinician should the need arise. Should I have thoughts of harming myself or others, I agree to call 911 to get immediate assistance.

It is the Alzheimer’s Foundation of America’s policy to protect the privacy and confidentiality of group members; only first names will be used during sessions. The Alzheimer’s Foundation of America does not share group members’ personal information (i.e., last name, email address, Facebook page, phone number or mailing address), unless required by law as described above.

I hereby release the Alzheimer’s Foundation of America, its employees, agents, staff, officers and directors from any claims, actions, losses, liability and/or other damages arising from or relating to my role as a member of the Therapeutic Recreation group (including, but not limited to, a situation in which I choose to share my personal information with other group members) and/or any exercise or activity I engage in as a member of such group.

I understand that this agreement means I give up my right to bring any claims including for personal injuries, death, disease, property loss or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen, or unforeseen.