Waiver Canada

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS AGREEMENT

I confirm that I have voluntarily chosen to attend services provided by Sweet Pea 3D Ltd. (“Sweat Pea 3D”) and give my consent and permission to perform and record this elective ultrasound (including 2D,3D,4D and 5D) on my fetus and me, solely for entertainment purposes. I understand these services are in no way to be used as a substitute for, or in lieu of, routine prenatal care by a physician or a healthcare provider, or to diagnostic ultrasound or any other tests or treatments that have been or may in the future be recommended by my physician or healthcare provider. I also confirm that I do not seek services offered by Sweet Pea 3D for any medical reason whatsoever, nor will I seek medical treatment or advice from agents and employees of, or any individual affiliated with, Sweet Pea 3D. I am solely responsible to inform my physician of any problems regarding my pregnancy, or any issues regarding this ultrasound session, and will not expect Sweet Pea 3D to communicate with any physician or healthcare provider further to any services provided by Sweet Pea 3D.

I confirm that I am under the care of a physician or other healthcare provider during this pregnancy and that they, and not Sweet Pea 3D, will address any and all concerns related to this pregnancy. I understand that the technologist performing the ultrasound session at Sweet Pea 3D will not attempt to provide a medically inclusive ultrasound or to confirm fetal well-being.

I understand that Sweet Pea 3D and its employees cannot guarantee image quality and that image quality will depend on many factors, including but not limited to developmental stage, fetus' position, amount of amniotic fluid, placenta location, and body habitus. All services and products purchased from Sweet Pea 3D are not refundable. In an event when the images are suboptimal, I understand that factors beyond our control may also affect the ability to accurately determine the gender of the fetus and that Sweet Pea 3D can provide no warranty or guarantees as to the accuracy of any such determination. The staff at Sweet Pea 3D will do their absolute best to ensure the quality and accuracy of gender determination, however.

Re-booking is done solely at the discretion of the staff members and cannot be requested. "Baby hiding" means that the face of the fetus is completely hidden and cannot be seen because the fetus has turned and is facing the pregnant client’s back, or the head is too low or is covered in such a way that no part of the face can be shown. If the fetus is covering its face with another body part, or the face is covered by the placenta or uterine wall, but a part of the face is visible, these images and the session will be considered successful, and you will be given all obtained images without an option to reschedule. If your appointment is re-booked, full payment is required at your first visit. Only one re-booking per payment. At the end of the second session images obtained at both sessions will be provided, whichever quality they may be. No refund on services rendered will be available.

I acknowledge that I have educated myself and have asked and received answers to all questions and addressed all concerns regarding the safety of 2D/3D/4D/5D ultrasound. I understand and hereby voluntarily assume all risk of harm or injury to me or my baby resulting from the services provided by Sweet Pea 3D.

In consideration of the Sweet Pea 3D Imaging permitting my use of their services, equipment and facilities, and for other good and valuable consideration, the receipt and sufficiency of which is acknowledged, I on my own behalf and on behalf of my baby hereby agree as follows:

  1. TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against the Sweet Pea 3D AND TO RELEASE Sweet Pea 3D from any and all liability for any loss, damage, expense or injury that I may suffer or that my next of kin may suffer, as a result of my obtaining an elective ultrasound, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY.OF CARE, INCLUDING ANY DUTY OF CARE OWED UNDER THE OCCUPIERS’ LIABILITY ACT, RSA 2000, c. O-4 ON THE PART OF Sweet Pea 3D;
  2. TO HOLD HARMLESS AND INDEMNIFY Sweet Pea 3D from any and all liability for any property damage, loss or personal injury to any third party resulting from my obtaining an elective ultrasound;
  3. This Release Agreement shall be effective and binding upon my and my baby’s heirs, next of kin, executors, administrators, assigns and representatives;
  4. This Release Agreement and any rights, duties and obligations as between the parties to this Release Agreement shall be governed by and interpreted solely in accordance with the laws of the Province of Alberta and no other jurisdiction; and
  5. Any litigation involving the parties to this Release Agreement shall be brought solely within the Province of Alberta and shall be within the exclusive jurisdiction of the Courts of the Province of Alberta.
  6. I am not relying on any oral or written representations or statements made by Sweet Pea 3D with respect to the safety of obtaining an elective ultrasound, other than what is set forth in this Release Agreement.
  7. SEVERABILITY - If any provision of this Agreement is determined by a court of competent jurisdiction to be invalid, illegal or unenforceable in any respect, such determination shall not impair or affect the validity, legality or enforceability of the remaining provisions hereof, and each provision is hereby declared to be separate, severable and distinct; and

In entering into this Release Agreement, I am not relying on any oral or written representations or statements made by Sweet Pea 3D with respect to the safety of obtaining an elective ultrasound, other than what is set forth in this Release Agreement. I confirm that I have read and understood the Release Agreement prior to signing it, and I am aware that by signing this Release Agreement I am on my own behalf and on behalf of my baby am waiving certain legal rights which I and my baby or our heirs, next of kin, executors, administrators, assigns and representatives may have against Sweet Pea 3D. 

Dated this _________ day of ___________, 20______.

Participant Signature: Last Name: PLEASE PRINT First Name: PLEASE PRINT
Street: City: Prov/State: Postal/Zip Code:
Age: Sex: Email Address: Phone Number: ()-
Witness Signature For Participants under the age of 18 Parent/Guardian Signature:
Witness Name: PLEASE PRINT Parent/Guardian Signature: PLEASE PRINT

I hereby give my permission for use of any photos or recorded data, including ultrasound images, by Sweet Pea 3D, I also give up all editing rights in favor of Sweet Pea 3D. The media may be published, reproduced, exhibited, copyrighted, and used in and published as a whole or in part for any purposes related to activities of Sweet Pea 3D and its agents and employees without further authorization or consent from or payment to me. I understand no names will be posted or used with this data.

I acknowledge and understand that all ultrasound images and photos stored or archived will not have client information attached and will not be available for retrieval at a later date. Sweet Pea 3D is not responsible for any digital media provided, or for any future changes to digital technology or media readers that might result in an inability to read data files provided. I will be responsible for safekeeping the digital media provided by Sweet Pea 3D, and will not seek a replacement.