Woods & Waters Medical Center

Release and Waiver of Liability

In consideration of an educational experience in the Woods and Water Medical Center, the undersigned
individual:

1. Hereby acknowledges that there are dangers and risks of personal injury or illness inherent with
observing the care and treatment of patients, in exposure to body fluids and other specimens,
and otherwise.
2. Hereby acknowledges that Woods and Water Medical Center is not responsible for any personal
injury, illness or other damages of any kind relating to my experience or exposure to patients,
body fluids or other specimens.
3. Hereby acknowledges that any body or personal injury, illness or other damages of any kind
arising out of or related to the educational experience will not be covered by workers
compensation insurance or any other insurance coverage provided to Woods and Water
Medical Center.
4. Hereby assumes responsibility for any risk of body or personal illness, injury, or other damages
of any kind arising out of or related in any way to the educational experience in the Woods and
Water Medical Center, including any risks caused by the negligence of Woods and Water
Medical Center.
5. Hereby releases, waives, forever discharges and covenants to hold harmless Woods and Water
Medical Center, its officers, directors, employees, insurers, and agents of an from all liability for
any and all loss of damage, and any claim or demand on account og personal or body injury
arising out of or related in any way to the educational experience in the Woods and Water
Medical Center, including any/all loss, damage, claim or demand arising out of the negligence of
the Woods and Water Medical Center.

The undersigned has read and understands this release and waiver of liability.

Date:
____________________________ Signed: ________________________________________

Name: _________________________________________
Date: Learner Signature
________________________ Signed: _________________________________________
Parent signature required if Learner under 18
Name: __________________________________________
Date: Print Learner Signature
Name: __________________________________________
Print parent Name

________________________ Department/Location:_____________________________