CLEAN VALLEY CIC'S 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:
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.
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.
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.
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.
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.
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.