Program Participation Release Form

Form/Letter
Employee & Labor Relations
Health & Wellness

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In regards to this participation, I understand the following:

  • I am not required to participate by any means;
  • If I do so choose to participate, any medical information that is to be supplied, or any medical examination that is necessary to undergo is strictly voluntary.
  • Participation in this program does not take the place of consulting a personal physician in any way; and
  • Neither the experts nor XYZ Company participating in this program assume any responsibility for diagnosis or treatment.
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