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, Dance Movement Therapist, Licensed Social Worker, or similar profession 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, that 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, that 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 the increased risk of contracting or spreading COVID-19.

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, without limitation, 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 obtain immediate assistance from a medical professional.

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 forever release, waive and discharge any and all liability, claims and demands of whatever kind or nature against the Alzheimer’s Foundation of America, and its representatives and agents, including without limitation its owners, officers, directors, managers, trustees, agents employees, volunteers or other representatives, either in law or equity to the fullest extent permissible by law, 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.