I agree to provide <company name> all the necessary personal and medical information required to carry out the check in services, and I also agree to provide <company name> immediately if there are any changes in the status of the client.

I agree to contact <company name> if I will not be present at the telephone location indicated for me in the <service name> database in order to eliminate false emergency calls which would be triggered if I was not home to answer them.

I understand that all of the information provided the <company name> will be held in the strictest confidence and released only to emergency professionals if I am unable to.

I agree, on my behalf, and on behalf on my guardian's, heirs, legatees, executors or administrators, to release <service name>, their officers, agents and employees, and to hold them harmless from any liability or for any injury, including death, or damage to my person or property which can be incurred as a result or performing or not performing the contracted operations of the <service name>.

Dated:__________ Day of:____________

Signature of client:_______________

Address:_____________________

Witness:_____________________

As a subscriber to our check-in service, you agree to make every effort to be at home during the time when the preprogrammed calling will begin.  By answering your telephone promptly when dialed and signaling your well-being with a touch tone, you acknowledge to our system that you are healthy.  Therefore never leave an answering on the phone line as it will interfere with our ability to reach you personally.  An answering machine would be interpreted by our equipment as a contact failure and immediately begin alerting your predefined list of third-parties.

1) Interruptions in service: <company name> assumes no liability for delays of it's automated dialing services due to strikes, riots, floods, fires, acts of god, mechanical and electrical equipment failures, or any cause beyond the control of <company name>, and will not be required to supply the <service name> while that interruption is in effect.

2) No Warranty or Representation: <company name> does not represent or warrantee that the system cannot be compromised or circumvented by both internal and external means in which case it will not provide the <service name> it was contracted for. <company name> expressly disclaims any implied or expressed warrantees including the merchantability or fitness for a specific purpose and the <client> acknowledges that any affirmation, fact or promise by it's agents, servants or employees shall not be deemed to create an expressed warrantee or contract beyond the writing on the face of this agreement.

3) It is understood and agreed, that <company name> is not an insurer.  Any insurer desired by the subscriber shall be obtained by the subscriber at their expense.

4) The subscriber acknowledges that it is impractical and extremely difficult to fix the damages, if any, which may proximately result from a failure by the <company name> and it's <service name> to perform any of the obligations herein, including, but not limited to: (1) the failure of the system to operate, (2) mechanical defects in the computer system, or (3) the <company name's> active or passive negligence with resulting loss or death to the subscriber because of, among other things:

   a) The uncertainty of a touch tone response solicited when messages are delivered by telephone.

   b) The uncertain nature of occurrences which might case injury or death to the subscriber or any other person which the system is designed to detect or avert.

   c) The limitation of the telephone lines or telephone service connecting the system

5) 3-rd Party Indemnification: The <client> agrees to and shall indemnify, defend and hold harmless the company, its employees, agents and related parties against and from all claims growing out of this agreement, or any alleged act of omission of the company relating to it's obligations undertaken or implied by this agreement brought against the subscriber or <company name> or related parties.

This indemnification and agreement to hold harmless includes but is, not limited to cost of the defense including attorney's fees, court costs and all related costs as well as any damages or any other loss.  This provision shall apply to all claims, regardless of cause, including the <company's name> perform or failure to perform whether based upon active or passive negligence, express or implied warranty, contribution, or indemnification or strict or product liability on the party of the <company name>, its employees or agents.

6) Full Agreement: This agreement constitutes the full understanding by and between the parties hereto, and may not be amended or modified, except in writing signed by both parties.  This agreement shall not be binding upon the <company name> unless signed by an authorized officer.

7) Assignment: It is specifically agreed that the subscriber shall not be permitted to assign this agreement without the prior written consent of the <company name> unless signed by an authorized officer.

8) Invalid Provisions: In the even that any of the terms or provisions of this agreement shall be invalid or inoperative, all of the other terms thereof shall remain in full force and in effect.

9) Right of Cancellation: You, the subscriber may cancel this contract at any time prior to midnight of the third day after the date of this transaction.

10) Governing Law: This agreement shall be governed by the laws of <your state>.

In Witness Thereof:, the parties have signed this agreement as of the date first written: