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															<td height="20" style="padding-left:10px" width="40%"><b>I hereby acknowledge that I have agreed to meet with</b></td>
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															<td colspan="3" style="padding:10px 0 0 10px;" width="100%">(the “HCP”)
At Alliston Physiotherapy and Sports Rehabilitation (the “Facility”) for Physiotherapy (the“Services”) (Services provided).<br><br>

I acknowledge and accept that there is a risk that I could be exposed to COVID-19 while attending the Facility.<br> I also acknowledge and accept that while receiving the Services, the HCP may need to be closer to me than the recommended social <br>distancing guidelines in order to assess and/or treat me. I acknowledge and confirm that I am willing to<br> accept this risk as a condition of attending the Facility to receive Services from the HCP.<br><br>

In consideration of the HCP agreeing to see me in person at the Facility, I agree to release the HCP and the Facility (if <br>applicable), their officers, directors, employees, agents, and volunteers (the “Releasees”) from any and all causes of action,<br> claims, demands, requests, damages, or any recourse whatsoever in respect of any personal injuries or other damages<br> which may occur or arise as a result of exposure to COVID-19 during my visit to the Facility<br> and/or through the provision of Services to me by the HCP.<br><br>

I do hereby acknowledge and agree that the notwithstanding the generality of the foregoing, I declare that I will not commence <br>litigation or otherwise seek to recover damages or other compensation against the Releases based on any action, claim, demand,<br> request, loss, or any recourse whatsoever arising from any potential or actual exposure to COVID-19 while attending at<br> the Facility and/or through the provision of services to me by the HCP. I further acknowledge that the Releasees can rely<br> on this Release of Liability, Waiver of all Possible Claims and Assumption of Risk as a complete<br> defense to any and all claims, damages, causes of action, or recourse, or liability that may arise at any time.<br><br>

I have carefully reviewed this Release of Liability, Waiver of all Possible Claims and Assumption of Risk and I fully acknowledge<br> that I fully understand the terms as set out above. I acknowledge that I am signing this Release<br> of Liability, Waiver of all Possible Claims and Assumption of Risk voluntarily.</td>
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			<td>&nbsp;</td>
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						<td width="50%" style="color:#fff">Call Us: <a href="tel:7054340645" value="7054340645" target="_blank" style="color:#fff;">  705-434-0645</a><br>
						
						Email Id: <a href="mailto:info@allistonphysiotherapy.ca" style="color:#fff;"> info@allistonphysiotherapy.ca</a>
						&nbsp;</td>
						
						<td width="50%" style="text-align:right;color:#fff;">  Address: 27 Victoria Street E, Alliston, <br>ON L9R 1T9, Canada </td>
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