WHIF Individual Grant Terms and Conditions
I confirm that this Application is being submitted by me and that I am age 18 or older. I understand that this Application and any Grant to me that may be approved by the WHIF is subject to the additional terms and conditions below.
1. WHIF may ask that I provide additional information including but not limited to tax documentation and statements from doctors or other health care providers regarding my diagnosis or other health issues.
2. I agree that WHIF may ask to use, in whole or in part, my name, likeness, biographical information, and any facts concerning or relating to the Grant in any advertising, press releases, promotion, commercial exploitation, marketing and any other documents for any lawful purpose. I may not use the name, likeness, biographical information, or any facts concerning or relating to the Grant without the prior written consent of WHIF.
3. WHIF may ask that I submit a picture of myself and a written testimonial (hand-written or electronic) and/or video describing the use of the Grant. The testimonial shall reflect my needs, how I found WHIF, how WHIF assisted me and how my life may be improved.
4. I agree to indemnify, defend and hold harmless WHIF, its officers, directors, employees and agents with any action or proceeding resulting from or arising out of, this Application or my actions or inactions related to this Application or the Grant.
5. Any Grant awarded by WHIF will be paid directly to service provider partners. I have voluntarily chosen to obtain the Grant to pay to the provider. I recognize that the services which I have or shall receive from the provider are solely at my request and may subject me potential risks, illnesses, injuries and even death. I have made my own investigation of these risks, understand these risks and assume them knowingly and willingly. Although WHIF is providing a Grant and making payment to the provider, I understand and acknowledge that WHIF is not responsible for any actions or omissions of the provider, its employees, staff, or agents, nor is it responsible for any illnesses, injuries or death that may arise as a result of the services that I am receiving from the provider.
To the maximum extent permitted by law, I release and hold harmless WHIF, and its officers, directors, staff, representatives, employees and agents, from and against any present or future claim, loss or liability for injury to person or property which I may suffer, or for which I may be liable to any other person, arising from the WHIF Individual Grant Program resulting from any cause, including but not limited to ordinary or gross negligence.
6. WHIF and I have no partnership, joint venture, agency, franchise, or employment relationship and
I shall not make any statement or take any action that I do. WHIF will not be bound or become liable because of any representations, actions, or omissions by me.
7. If any provision of these terms is for any reason held to be invalid, illegal, or unenforceable, that shall not affect any other provision of these terms.
8. No waiver of any breach of any provision of these terms will constitute a waiver of any other breach of the same or any other provision of these terms, and no waiver will be effective unless made in writing.
9. This Application and these Terms must be construed and enforced exclusively under the laws of the State of Ohio without regard to its conflicts of laws principles. Any dispute arising out of or related to this Application and these Terms must be commenced (if at all) and prosecuted in the courts located in the State of Ohio, Montgomery County. The parties agree to submit to the jurisdiction and venue of such courts.
10. I represent that I have carefully reviewed and understand the Application and these terms. This Application and any Grant by WHIF constitute the entire agreement between me and the WHIF concerning my Grant Request. This Application supersedes any and all prior or contemporaneous agreements, whether oral or in writing, between the parties with respect to the subject matter. No change, amendment or modification of this Application will be valid unless it is in writing and signed by the party to be charged.
11. I may not assign in whole or in part, or subcontract, my rights, or obligations under this Application.