top of page
Mosaic Therapy Services LLC and Mosaic Therapy LLC Liability Waiver

Mosaic Therapy Services, LLC and Mosaic Therapy, LLC (individually and collectively “Mosaic Therapy”) and each’s managers, directors, officers, employees, and agents, and the heirs, executors, personal representatives, successors and assigns of each of them (“Mosaic Parties”). Client desires to engage the services of Mosaic Therapy (any and all such activities shall individually and collectively be known as the “Therapy,” regardless of whether the activity is specifically related to a therapeutic purpose). Client understands that these activities may include providing speech therapy, occupational therapy, cognitive therapy, use of toys, tools and other equipment, including but not limited to  use of the gymnasium, and interacting in close proximity or with physical contact. Client does hereby freely, voluntarily, and without duress, give this Release under the following terms:

1. Waiver and Release. Client does hereby release and forever discharge and hold harmless each of the Mosaic Therapy Parties from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from the Therapy and does covenant not to sue any of the Mosaic Therapy Parties with respect to such matters. Without limiting the generality of the foregoing, Client understands and agrees that this Release discharges each of the Mosaic Therapy Parties from any liability or claim that Client may have against any of them with respect to any bodily injury, personal injury, illness, death, or property damage that may result from the Therapy or use of any of Mosaic Therapy’s equipment, property, or premises, whether caused by the negligence of a Mosaic Therapy Party or otherwise. Client also understands and agrees that Mosaic Therapy does not assume any responsibility for or obligation to provide financial assistance or any other assistance in the event of injury or illness.

CLIENT SHALL INDEMNIFY, DEFEND, HOLD HARMLESS, AND PROMISE NOT TO SUE THE MOSAIC THERAPY PARTIES FROM ANY AND ALL LIABILITIES OR CLAIMS MADE AS A RESULT OF ENTERING MOSAIC THERAPY’S PREMISES OR PARTICIPATING IN THE THERAPY, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE.

2. Medical Treatment. Client does hereby release and forever discharge the Mosaic Therapy Parties from any claim whatsoever which arises on account of any first aid, treatment or service rendered in connection with the Therapy.

3. Assumption of the Risk. Client understands that the Therapy may include activities that may be hazardous to the Client, including, but not limited to use of tools and equipment, use of the gymnasium, and exposure to infection or illness. Mosaic Therapy shall not be required to provide Client with any particular safety or protective equipment. Client hereby expressly and specifically assumes the risk of injury or harm in these activities, whether caused by the negligence of a Mosaic Therapy Party or otherwise.

4. Insurance. Client understands that Mosaic Therapy does not carry or maintain health, medical, or disability insurance coverage for any Client. Each Client is strongly encouraged to have adequate medical or health insurance coverage in effect.

5. Other. Client expressly agrees that this Release is intended to be as, but only as, broad and inclusive as permitted by the laws of Florida. Client agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release, all of which shall continue to be enforceable.

PARENTAL PERMISSION

 In consideration of the opportunity afforded my (our) child to receive the Therapy, and other good and valuable consideration the receipt of which is hereby acknowledged, I (we) give my (our) permission for my (our) child to participate in the Therapy, and I (we), on behalf of my (our) child and myself (ourselves) agree to the terms and conditions set forth in this Release such that all recitals, acknowledgements, understandings, releases, waivers, discharges, assumptions of risk, covenants, grants, conveyances, and other agreements of Client so set forth shall be binding upon me (us) and my (our) child with respect to the participation of my (our) child in the Therapy. Without limiting the generality of the foregoing, I (we), on behalf of my (our) child and myself (ourselves), do hereby release and forever discharge, hold harmless, and indemnify each of the Mosaic Therapy Parties from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my (our) child’s participation in the Therapy.

Thanks for submitting!

bottom of page