I, the undersigned participant, request assistance for myself for the following items, assistance to the restroom, assistance to my form of transportation, assistance in any manner which Shore Cardiology Consultants LLC and the officers, directors, employees, and agents of each is requested to assist me outside of their covered entity. The items stated will be classified as “activities” throughout the remainder of this agreement.

I consent to participation in the activity and acknowledge that I fully understand my participation may involve risk of serious injury or death, including losses which may result not only from my own actions, inactions or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment ,or areas where the activity is being conducted, and/or this type of activity. I understand that if I have any risk concerns, I should discuss the risks associated with my participation with the activity.

I agree to use my personal medical insurance as a primary coverage payment if accident or injury occurs. I consent to emergency medical treatment in the event such care is required.

Knowing and understanding the risks involved with participation in the activity, I hereby voluntarily and willingly assume responsibility for all the risks and dangers associated with my participation in the activity. I agree I am financially responsible for any losses resulting from my actions and will indemnify Shore Cardiology consultants LLC and the officers, directors, employees, and agents of each of them, for any loss or damage caused by myself during this activity.

In consideration of my participation in the activity, I hereby waive all claims or causes of action against Shore Cardiology Consultants LLC and the officers, directors, employees, and agents of each of them arising out of my participation in the activity and hereby forever release, hold harmless, and discharge Shore Cardiology Consultants LLC and the officers, directors, employees, and agents of each of them from all liability in connection therewith.

I have read this release and hold harmless agreement and understand the terms used in it and their legal significance. This waiver and release is freely and voluntarily given with the understanding that right to legal recourse against Shore Cardiology Consultants LLC and the officers, directors, employees and agents of each of them is knowingly given up in return for allowing my participation in the activity. My signature on this document is intended to bind not only myself but also my successors, heirs, representatives, administrators, and assigns.