Release form for frequency treatment

[Richard Di Nucci]

Release Form for Rife Frequency Treatment – Revision 5

I, ______________________________ fully acknowledge the implications of the following seven (7) paragraphs listed below; further, I fully understand, acknowledge, and accept the potential consequences either expressed or implied by these statements below.

1. I have received an experimental Rife device, Model # ______________________ (hereinafter referred to as “device”) on temporary loan, for a period of two weeks, from ____________________________(name of device owner) on the date shown below. Further, while in my possession, I am responsible for the safe-keeping of this device.

2. I have been trained in the specific procedures that are to be used in connection with the safe operation of this experimental device, and I have been trained in specific safety precautions that are to be followed, before, during and after the use of this device.

3. This device will be used by me only, and I agree that I will not allow other persons to use it while it is in my possession.

4. Use of this device is for education and entertainment purposes only.

5. The duration when this device is in my possession is specified in Paragraph # 1 as two (2) weeks; however, the device owner may grant me additional time to use this device. Further, there may be occasions when the device owner may require this device while it is in my possession. In that event, the device owner will provide a 24 hour "advanced notice" to me, that the device must be returned on the following day.

6. The device owner is receiving no compensation of any kind for allowing me to borrow this device.

7. The Temporary User of this device has been advised to seek the counsel of a licensed medical practitioner if they believe that they are ill.


Signed below by the Owner and the Temporary User of this Device:


_______________________________________
Temporary User of Device Date

_______________________________________
Owner of This Device Date


Comment to Forum Members: Feel free to use this template, or modify it in whatever way you wish; if there is another template that has been used and found to be acceptable by Rifers, please provide info about it, or a link to it within this thread.

[Arrow Durfee]

Yes, this last one is the one to use.

You are loaning the device and therefor have no culpability for what an individual may use it for.

you might consider adding that this device is not for the use of treating or curing any physical condition. All applications of frequency are experimental and unproven. This person has been advised to seek the counsel of a licensed medical practitioner.

[Richard Di Nucci]

Arrow:

Good points, all of them, and a welcome addition.

While I could add most of your additions, I believe I've covered the "on loan" topic and the "no culpability" topic sufficiently. Do you agree?

I believe your other major point ("not for treating or curing any physical condition") is worthy of consideration, and makes no inference for such use.

My Thoughts on Your Last Sentence:
("This person has been advised to seek the counsel of a licensed medical practitioner"). Looking at this sentence from the legal person's perspective, it draws too much attention to the inference that the person may, in fact, use it for medical reasons.

In regard to this "inference" stated above, I welcome your perspective, and perspectives from others as well.

Richard
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[Arrow Durfee]

Well trying to deny that this is going to be used for medical issues is another layer of denial. You know, your client or friend knows and so does the prosecutors and FDA as well as any judge.

Change the sentence to say. This person has been advised to seek the counsel of a licensed medical practitioner if they believe that they are ill.

It is a cover your butt sentence.

[Richard Di Nucci]

Arrow:

This afternoon, while doing some other work, I had time to reflect on these points, and ironically, I came to the same conclusion that you did!

I'll insert that sentence into the prior draft, and call it a new revision; that version should be sufficient as a starting point for someone who wants to draft a contract, and they can refine it further if they wish.

Tnks for your suggestions.

Richard
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[Max Reese]

thank you richard for your hard work

please don't get upset if i suggest one minor point.

in paragraph 5 instead of "after five [5] days" i would suggest instead

"by giving me 24 hours advance notice"

i only have one good machine and i might need it an emergency!

[Richard Di Nucci]

Max:

None of us should ever be offended if we ask post some idea, then ask for suggestions . . . whether we agree with them or not. In this case, your suggestion is actually a very good one, since most Rifers have only one Rife Machine, and are in the same predicament as you.

Free to Change Any Part of the Release Form Agreement:
I certainly will incorporate your comment, but please recognize that the draft "Template" above are just words, and all Rifers who see this Release Form and want to use it, are free to change it in whatever way they wish, in order to suit their individual needs.

So whenever you plan to use this form, please change, add to, or delete any portion of the wording in the associated paragraphs in whatever way you wish.

[Karl Buchanan]

Yes, this last one is the one to use.

You are loaning the device and therefor have no culpability for what an individual may use it for.

you might consider adding that this device is not for the use of treating or curing any physical condition. All applications of frequency are experimental and unproven. This person has been advised to seek the counsel of a licensed medical practitioner.

You will tell the judge you advised them to see a dr but still rented them a unit?