The Embrace Foundation Acknowledgment of Risk and Acceptance of Responsibility

Please read this document before checking the box below. You must read and understand it before signing. In consideration of the services provided by The Embrace Foundation, I hereby covenant and agree as follows:

1. I understand and acknowledge that I am accepting supplies that have been donated by another party. All supplies have been inspected and sanitized thoroughly, however, I understand the risk of accepting second hand supplies. I do not hold The Embrace Foundation, its directors, board members, employees, volunteers and all other persons or entities acting in any capacity on its behalf, responsible.

PRESCRIPTION ACKNOWLEDGEMENT

2. The Embrace Foundation does not write prescriptions or give away diabetic supplies to individuals without a prescription written by a medical professional.

By checking “yes” in the box below, I acknowledge that I have a current prescription for supplies requested. I have reviewed the list of supplies that need a prescription and acknowledge that I have a prescription for each item that needs one.

AT NO COST ACKNOWLEDGEMENT

3. I acknowledge and understand that any monetary donations, diabetic supply donations, or shipping fee coverage is not an exchange for diabetic supplies received by The Embrace Foundation. The supplies I am receiving by The Embrace Foundation will be donated to me at no cost for the items themselves.

By signing below, I hereby acknowledge that I have completely read and fully understand The Embrace Foundation acknowledgement of risk and acceptance of responsibility form. I also affirm the truth of the following statements:

- I am a diabetic or pre diabetic.

- I can not afford or obtain these items myself.

- I will not resell items given to me by The Embrace Foundation.