Free Employee Waiver of Medical Treatment Template
EMPLOYEE WAIVER OF MEDICAL TREATMENT
This Waiver is made and entered into as of September 29, 2084 by and between:
Employee Name: Dell Stokes
Employee ID (if applicable): 12345
Department: Marketing
Employer Name: Etha Lehner
Employer Address: [YOUR COMPANY ADDRESS]
1. Purpose of Waiver
This Employee Waiver of Medical Treatment (the “Waiver”) is designed to inform the employee of their rights and to obtain the employee's consent regarding the decision to forgo medical treatment provided by the employer's health services during emergencies, including but not limited to natural disasters or other crises.
2. Acknowledgment of Emergency Situations
The employee acknowledges and understands that during emergency situations, the employer may provide medical treatment or health services, which the employee may choose to accept or decline.
3. Voluntary Decision
By signing this Waiver, the employee voluntarily chooses to decline medical treatment offered by the employer during an emergency situation. The employee acknowledges that:
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They are fully aware of the risks involved in refusing medical treatment.
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They understand that refusing treatment may result in adverse health consequences.
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They are making this decision freely and without coercion.
4. Release of Liability
The employee hereby releases, waives, and discharges the employer, its employees, agents, and representatives from any and all claims, liabilities, or causes of action arising out of or related to the employee's decision to decline medical treatment during the aforementioned emergency situation.
5. Indemnification
The employee agrees to indemnify and hold harmless the employer from any claims, damages, losses, or expenses arising out of the employee's refusal of medical treatment during an emergency situation.
6. Governing Law
This Waiver shall be governed by and construed in accordance with the laws of the state of New York.
7. Severability
If any provision of this Waiver is found to be invalid or unenforceable, the remaining provisions shall continue in full force and effect.
8. Acknowledgment of Understanding
The employee certifies that they have read this Waiver in its entirety, fully understand its contents, and voluntarily sign it. The employee acknowledges that they have had the opportunity to ask questions and seek independent legal advice if desired.
Dell Stokes
Employee
Date: October 29, 2084
Etha Lehner
Employer
Date: October 29, 2084
