Welcome to the Neuro Life Online™. We are excited to have you join the community. Before getting started we have three short forms for you to complete.
- The first form is a Release of Liability.
- We also need each person (the person with Parkinson’s, Huntington’s or another movement disorder to complete a confidential survey. The survey is a validated instrument that helps us evaluate the program and experience. You will complete it now and we will send it to you again in three and six months. The surveys measure wellness, anxiety and depression. The scales are also important for use in obtaining grants and funding support, which help offset the need for higher membership fees.
All information and the survey results are confidential.
Please feel free to contact us if you have any questions or concerns. We can be reached at 800-256-0966 or you can email us at NeuroLifeOnline@PMDAlliance.org
Move It!™ Waiver / Release Form
Every individual participating in this class must sign a separate form.
By completing the form below, I hereby voluntarily indemnify, and release from liability and hold harmless the Parkinson and Movement Disorder Alliance and Move It!™ Instructors for any accidental falls, injuries, damages or other consequences suffered by me or any other person arising or resulting directly or indirectly from my participation in Move It! ™ exercise class.
I understand it is my responsibility to consult with a physician regarding participation in exercise. In the event that I am injured, I agree to assume any and all financial obligation for any medical costs and related expenses. Instructors and PMDAlliance assume no responsibility for any medical expenses, injury, or damage suffered by me in connection with Move It! ™
I further agree that my spouse, assignees, heirs, guardians, and legal representatives will not make any claim against, attachment to, or sue PMDAlliance or Move It!™ Instructor for any loss or damage resulting from my participation in Move It!™ class.
I am aware that this is a release of liability and a waiver of my right to collect damages in the event of a fall or injury. I am signing this at my own free will.
Survey for Person with Parkinson’s, Huntington’s or Another Movement Disorder to Complete: