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Commercial Insurance Patient Waiver of Liability (Nonmedical) Do not use this waiver for BCBS ND members or Medicare beneficiaries. Separate payer specific waiver required. Patient Name (Print) ___E#
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How to fill out waiver of liability statement

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Start by downloading a template of a waiver of liability statement.
02
Read through the document carefully to ensure you understand all the terms and conditions.
03
Fill in the blanks with the relevant information, such as your name, the date, and the activity or event for which the waiver is being signed.
04
Include any additional clauses or provisions that may be necessary depending on the specific circumstances.
05
Have the document reviewed by a legal professional to ensure its accuracy and effectiveness.
06
Sign and date the waiver in the presence of a witness or notary public to make it legally binding.
07
Keep a copy of the waiver for your records.

Who needs waiver of liability statement?

01
Anyone organizing a potentially risky activity or event, such as a sports competition, outdoor adventure, or fitness class.
02
Businesses offering services that involve some level of risk, such as gyms, fitness centers, or recreational facilities.
03
Organizations hosting events where participants may be exposed to potential dangers, such as concerts, festivals, or charity runs.
04
Individuals or groups renting out property or equipment to others, such as landlords, equipment rental companies, or property owners.
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A waiver of liability statement is a legal document that releases one party from liability for any potential damages or injuries that may occur during a specific activity or event.
Individuals or organizations hosting events or activities where there is a risk of harm or injury are typically required to have participants sign a waiver of liability statement.
To fill out a waiver of liability statement, participants must provide their personal information, agree to the terms and conditions, and sign the document.
The purpose of a waiver of liability statement is to protect the party hosting the event or activity from legal claims in case of accidents or injuries.
A waiver of liability statement typically includes the participant's name, contact information, signature, acknowledgement of risks involved, and a release of liability clause.
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