SuiteRomeo Registration

* Last Name:  
* First Name:  
Middle Name:
* Email Address:  
   
* Confirm Email Address:  
 
* Password:  
 
* Confirm Password:  
Work Phone:
Cell Phone:
* Company Code:    
Seity End User License Agreement
 
In consideration of being able to participate in various activities with the Seity program, You, the undersigned, on your own behalf, and on behalf of any executors, heirs, successors and assignees hereby acknowledge and agree as follows:
 
1. Release of Claims: In consideration of participation in this health screening, You hereby agree to assume all risks of injury or death. You agree that the Seity program and screening personnel shall not be liable for any damages arising from my personal injury or death. YOU HEREBY RELEASE SEITY AND ALL OF ITS PERSONNEL AND AGENTS FROM ANY AND ALL DAMAGES AND CLAIMS CAUSED BY OR RESULTING FROM MY PARTICIPATION IN SEITY ACTIVITIES OR SCREENING.
 
2. You knowingly and fully assume all risks, known and unknown, associated with participation in activities associated with the Seity program and waive all claims for damage to person or property loss whether arising from (i) negligence or carelessness on the part of the persons or entities being released and other participants, or (ii) dangerous or defective equipment.
 
3. You certify that you are physically fit and may participate in the activities coordinated by the Seity program and have not been advised otherwise by a qualified medical person.
 
4. You agree to comply with the rules and conditions of participation expressed or posted by the Seity program. If You observe any significant hazard during such participation, You will promptly inform an employee of Seity.
 
5. Explanation and Purpose of the Health Risk Assessment: A volunteer health screening may include the following tests: the taking of a blood sample by a finger stick for cholesterol and glucose levels, a blood pressure check, and BMI computation. The purpose of this screening is purely educational to raise your awareness of good health practices. Any feedback You receive in connection with this health screening is not intended to replace the advice of your physician/provider.
 
6. Responsibilities of the Participant: You agree that if any screening tests are performed and are found to be outside of normal range, You will follow up with your Primary Care Physician/Provider for assessment and management, to be determined by your Primary Care Physician/Provider. You understand that your results will NOT automatically be sent to a medical provider on my behalf. Furthermore, You acknowledge that You are responsible for any and all additional costs for additional medical services that result from Seity program activities or communications. You agree that You will not participate in this health screening without fully understanding the potential risks of doing so. Prior to participation, You agree to gain full understanding of the risks of the procedures to be performed by contacting and discussing with a Seity staff member.
 
7. Risks: Symptoms that may occur during a Health Risk Assessment or other Seity program activity include but are limited to abnormal blood pressure, fainting, irregular or fast or slow heart rhythm that may lead to a heart attack, stroke, other serious health condition, or even death. Emergency equipment and trained personnel are not provided by Seity to deal with these situations should they arise. As a participant, You take full responsibility to seek medical attention if any symptoms develop.
 
8. Confidentiality: Any personal health information obtained in conjunction with your health screening or other Seity program activities will be kept confidential and will not be released or revealed to any person without your written consent. The information obtained, however, may be used for research or statistical purposes so long as the same does not provide facts that directly identifies you.
 
9. Photography: You hereby grant Seity the right to use all videotape and photographs taken during Seity program functions for programming, publicity and advertising purposes without payment.
 
10. Electronic Communication: You hereby grant Seity the right to send electronic communication, including (but not limited to) phone calls, e-mails, newsletters, surveys and text messages.
 
11. Sharing of Personal Information with MedicAlert: You hereby grant Seity explicit permission to share your personal information with MedicAlert to establish and/or confirm the eligibility of Seity program participants. This information may include, but is not limited to, the organization name You are affiliated with, and Your first and last name, gender, date of birth, and email address.
 
12. Freedom of Consent: You acknowledge that You have read this document in its entirety (or that it has been read to You). If You are under age 18, You agree not to participate in this health screening without the written consent of your parent or legal guardian. Your permission to perform this health screening is given voluntarily and extends to all screening personnel, including volunteers. You understand that You are free to stop the tests at any point, if so desired. You also fully understand the attendant risks and discomforts, and have had an opportunity to ask questions that have been answered to your satisfaction.
 
PARENT/GUARDIAN WAIVER FOR MINORS (Under 18 years old)
 
The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward to participate in all Seity activities or events, and has agreed individually and on behalf of the child or ward, to the terms of the waiver and release of liability set forth in the SEITY USER AGREEMENT. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to in the SEITY USER AGREEMENT from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.
 
Account Setup Successful!
You will now be redirected to the Sign In page where you can use your new account to sign into SuiteRomeo.