Application for TIL Services

I authorize the Technology for Independent Living program, and/or its representatives to release to or obtain from such agencies, individuals, medical centres or hospitals as are concerned with my medical rehabilitation, any and all pertinent information which may be necessary to assist in providing me with medical rehabilitation services.

I declare that any information which has been provided in order for the Technology for Independent Living program to determine my eligibility to receive services at no cost, or at reduced cost, is true to the best of my knowledge and belief.

I understand that all such information will be treated as confidential and privileged, and used only for the purpose of assisting my medical rehabilitation.

I am nineteen years of age or older.

I understand that, upon my approval for assistance from Technology for Independent Living, I will automatically become a member of Technology for Living.

The applicant authorizes the Technology for Independent Living program, and/or its representatives to release to or obtain from such agencies, individuals, medical centres or hospitals as are concerned with their medical rehabilitation, any and all pertinent information which may be necessary to assist in providing them with medical rehabilitation services.

The applicant declares that any information which has been provided in order for the Technology for Independent Living program to determine their eligibility to receive services at no cost, or at reduced cost, is true to the best of their knowledge and belief.

The applicant understands that all such information will be treated as confidential and privileged, and used only for the purpose of assisting their medical rehabilitation.

The applicant is nineteen years of age or older.

The applicant understands that, upon their approval for assistance from Technology for Independent Living, they will automatically become a member of Technology for Living.

Liability Disclaimer and Member Responsibilities
By accepting and using any device provided by Technology for Living (“TFL”), the member agrees to the following terms:

1. Proper Use
o The member agrees to use the TFL-provided device solely for its intended purpose and in accordance with any instructions, guidelines, or training provided by TFL.

1. Prohibited Uses
o The member shall not use the device in any emergency situations where failure of the device may result in harm, injury, or death.
o The member shall not modify, tamper with, or alter the device in any way.
o The member shall not use the device in any manner that is unsafe, illegal, or contrary to the intended purpose of the device.

1. Limitation of Liability
o TFL is not responsible for any harm, injury, disability, death, or loss of any kind resulting from the misuse, modification, or inappropriate use of the device by the member.
o TFL does not guarantee that the device will function in all situations or that it will prevent any harm or injury.
o The member acknowledges and accepts all risks associated with the use of the device.

1. No Legal Recourse Against TFL
o The member, their heirs, representatives, or assigns shall not hold TFL, its staff, affiliates, or partners liable for any direct, indirect, incidental, consequential, or special damages arising from the use or misuse of the device.

1. Indemnification
o The member agrees to indemnify and hold harmless TFL from any claims, demands, liabilities, damages, or expenses (including legal fees) arising from their use of the device in a manner not in compliance with these terms.