CLEAN VALLEY BIO-FILTRATION TECHNOLOGIES CIC WAIVER

This waiver is between the undersigned and Clean Valley Bio-Filtration Technologies CIC in Dartmouth, Nova Scotia regarding their Bio Filtration Mask. 

 

By signing this form, I hereby understand and agree to the following: 

  1. That I am participating in an experimental mask trial offered by Clean Valley Bio-Filtration Technologies CIC. These are not yet NIOSH certified and are not considered to be medical or PPE grade masks. They are currently in the development phase.

  2. I understand that it is my responsibility to inform Clean Valley Bio-Filtration Technologies CIC of any known allergies, prior to participating. The masks contain a food grade additive that is extracted from red Irish moss. By signing this form, I am aware that the masks contain this ingredient and that I, the undersigned, have no known allergy to red Irish moss or any chance of an allergic reaction to this ingredient.

  3. I understand that it is my responsibility to return this mask at the end of the two-month trial. I understand that I am not to wear this mask to replace what I currently use in public to protect myself against COVID-19. I am to wear this mask on my own time, not in public places where there is a risk of contracting COVID-19.

  4. By signing this waiver, I agree to assume full responsibility for any risks, injury or damages which I might incur as a result of participating in this mask trial. 

  5. I knowingly, voluntarily, and expressly waive any claim that I might have against Clean Valley Bio-Filtration Technologies CIC related to the Bio Filtration Mask. 

  6. I understand that my personal information is collected solely for the purpose of tracking inventories of the mask and will not be shared with anyone. I will be contacted by Clean Valley Bio-Filtration Technologies CIC following the two-month trial only if I check the box below. 

By checking this box, I agree to fill out a follow up survey regarding the mask suitability, breathability, temperature control, and other key elements of my experience.

I have read the above release and waiver of liability and fully understand its contents. I am 18 years of age or older and I voluntarily agree to the terms and conditions stated above.

© 2019 Clean Valley CIC,  371 Prince Albert Road, Dartmouth, NS, B2Y 1N8

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