AWAKE Mentee Participation Acknowledgment
By submitting this form, I understand and agree that:
1. I am voluntarily enrolling as a Mentee in the Wellness, Sleep & Circadian Network’s (“WSCN’s”) AWAKE Peer Mentor Program (the “Program”), a free charitable peer-support initiative that connects individuals new to positive airway pressure (“PAP”) therapy with volunteer peer mentors (“Mentors”) for informational and experiential sharing and support only.
2. I am at least 18 years of age.
3. The Program is not a clinical service and is not a substitute for medical care. I will maintain an ongoing relationship with my own qualified healthcare provider for all PAP therapy management.
4. Mentors are volunteer peers, not licensed professionals acting in any licensed capacity through the Program. Nothing shared in the Program is medical, psychological, legal, financial, or other professional advice, and I will not rely on any Mentor statement as a clinical recommendation.
5. Participation does not create any professional, clinical, fiduciary, or doctor-patient relationship with WSCN, any Mentor, or any other participant.
6. Information I share in the Program is not protected by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) or by clinician-patient privilege. I should share only what I am comfortable sharing in a peer-support context.
7. I will treat all participants with respect and will not engage in harassment, discrimination, threats, intimidation, hate speech, or other conduct a reasonable person would consider inappropriate. I will not record any Program interaction without the advance written consent of all participants and WSCN.
8. If I am experiencing a medical emergency, I will call 911 or my local emergency services immediately. The Program is not an emergency or crisis service.
9. WSCN may collect, use, and store information I provide to administer and improve the Program, consistent with WSCN’s Privacy Policy.
10. This Acknowledgment is governed by the laws of the District of Columbia, without regard to conflict-of-laws principles. This Acknowledgment, together with the AWAKE Peer Mentor Program Disclaimer and WSCN’s Privacy Policy, constitutes the entire agreement between me and WSCN regarding my participation in the Program as a Mentee. If any provision is unenforceable, the remaining provisions remain in effect.
TO THE MAXIMUM EXTENT PERMITTED BY LAW, I RELEASE WSCN AND ITS DIRECTORS, OFFICERS, EMPLOYEES, VOLUNTEERS, MENTORS, CONTRIBUTORS, AND AGENTS (THE "WSCN PARTIES") FROM ANY CLAIM, CAUSE OF ACTION, OR LIABILITY ARISING FROM MY PARTICIPATION IN THE PROGRAM, MY INTERACTIONS WITH OTHER PARTICIPANTS, OR MY RELIANCE ON ANY PROGRAM CONTENT. IN NO EVENT SHALL ANY WSCN PARTY BE LIABLE FOR ANY INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, EXEMPLARY, OR PUNITIVE DAMAGES, OR FOR PERSONAL INJURY, DEATH, OR PROPERTY DAMAGE ARISING OUT OF OR RELATING TO THE PROGRAM. THIS LIMITATION DOES NOT APPLY TO CLAIMS ARISING FROM THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF ANY WSCN PARTY.
