Aestra Institute Consent, Waiver and Indemnification Form
I do hereby acknowledge, agree and affirm that I will indemnify and hold harmless, Denise Merdich, APRN/ CEO Aestra Instititute, LLC , and any and all employees, servants and agents of Aestra Institute, LLC from any and all claims, obligations, responsibility, lawsuits, or damages arising from conduct, care or services provided by me to anyone during this clinical training that I am participating in on or about:
I further understand, represent, warrant and promise that I have a valid medical license and that all of my conduct, care and services provided as part of this training are covered by my own liability insurance carrier, or that, alternatively, I will accept responsibility for my own conduct and the services that I provide during said training and will indemnify and save harmless Aestra Institute, LLC its employees, agents and servants and Ms. Merdich as above.
I acknowledge that I have been informed that in order to directly provide aesthetic services to models within Florida, I must comply with Florida law. I am aware that this is my sole obligation and that Aestra Institute will not be responsible for researching or making sure that I have complied with Florida law. I represent and warrant that I have complied with Florida law and have obtained any necessary licensure for the direct provision of aesthetic services, including any necessary provider to supervise me if that is required.
Thank you for your consent!