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Global Tactile, LLC

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High Performance Cybernetics

Covenant

What is this all about?

Please read carefully, or have someone read this form carefully to you. Fill in the appropriate information with your name, address, etc. You will find the section for your information after the legalese.

After reviewing the entire Covenant Terms, fill in your Contact Details and click “Submit Form”. A printable pdf with two pages will be prepared and sent to your email address.

Page 1 will be a copy of the Covenant Not To Sue.

Page 2, if applicable, is for your Vision Specialist to complete. If you have impaired vision, make sure your Vision Specialist fills out the form or attaches the appropriate visual acuity information.

Finally, have a Notary witness your signature on the Participant line.

When completed, please mail the original signed form to:

Global Tactile, LLC
155 E Capitol Dr, Ste 9F
Hartland, WI 53029

COVENANT NOT TO SUE

WHEREAS, Global Tactile, LLC, a Wisconsin corporation, operates and supervises recreational programs including but not limited to: disc golfing, base running, canoeing, sailing, skating, skiing, camping, fishing, precision fly-casting, orienteering, choreography, dancing, stone putting, caber tossing, axe throwing, archery, and similar activities; and

WHEREAS, the undersigned desires to participate in the said programs and is willing to assume the risk attendant to such activities, NOW, THEREFORE, in consideration of being allowed to participate in recreational programs sponsored by Global Tactile, LLC, I hereby release and forever discharge for myself and for my heirs, executors, administrators and assigns the said Global Tactile, LLC of and from all claims, demands, damages, actions or causes of action which may hereafter arise on account of any injury which may be sustained by me as a result of, or arising out of, or connected in any way with my participation in any recreational activity or program sponsored by, supervised by, or in any way conducted under the auspices of the said Global Tactile, LLC and which I, my heirs executors, administrators, or assigns, may have by reason of any such matter, cause or thing.

I further state that I have read and that I understand the foregoing and that I understand that I would not be allowed to participate in the said recreational activities but for the execution of this Agreement.

Contact Details First Name(required) Last Name(required) Company (for commercial licenses) Primary Phone(required) Secondary Phone Email Address(required) Street Address(required) Street Address City(required) State(required) Zip(required) Vision (for individual licenses) Normal Vision Visually Impaired Gender (for individual licenses) Female Male Not Disclosed Date of Birth (for individual licenses) (YYYY-MM-DD) Message [submit form]

Global Tactile, LLC

155 E Capitol Dr, Ste 9F
Hartland, WI 53029

Phone: 262-563-1145

Email: info@globaltactile.com

Research reported in this publication was supported by the National Eye Institute of the National Institutes of Health under Award Number R43EY032008. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.