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Snacks & Chats
Biofilm Management & Air-Polishing
Hygiene Hub: OHI & Patient Education
Standard of Care Program
Tech Partnerships Enablement

Forms

Please Sign

Training Participation Waiver and Release of Liability

Please read each statement carefully. This form affects your legal rights.

Full name*

Email*

Phone*

Clinic name*

Clinic city and province*

Training date*

Year

Month

Day

Training type*

Virtual

In person

Role*

Trainee clinician

Practice partner (being practised on)

Clinic owner or manager

Licence/registration number (trainees only, optional)

Read each statement and check to agree

1. Education only. I understand Rovix Dental Hub provides education on how to use dental equipment. Rovix Dental Hub and its trainers do not provide clinical treatment, diagnosis or clinical supervision.

2. My own scope. If I perform any hands-on practice, I do so under my own licence and within my scope of practice and my regulatory college's standards. I am responsible for reviewing my practice partner's medical history for contraindications before starting.

3. Known risks. I understand hands-on practice carries risks, including but not limited to gum or soft-tissue irritation or injury, bleeding, tooth sensitivity, aerosol exposure, eye injury, allergic reaction, air emphysema and equipment-related injury.

4. Voluntary. My participation is voluntary. I may stop, or decline to be practised on, at any time.

5. Virtual trainings. For virtual sessions, I understand any hands-on practice happens without a Rovix Dental Hub trainer physically present.

6. Release. To the fullest extent permitted by law, I release and waive all claims against Rovix Dental Hub, its owner, trainers and contractors for any injury, illness, loss or damage arising from this training, including claims arising from negligence.

7. Understood. I am 18 or older, I have read and understood this form, I have had the chance to ask questions or get legal advice, and I am signing voluntarily.

Governing law: This form is governed by the laws of the province where the training takes place.

Signature*

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Date*

Year

Month

Day

Photo, Video and Interview Consent (Training)

Rovix Dental Hub will take photos and video during today's training (in person, or recorded on screen for virtual sessions), and may record short interviews with some participants. This form lets you choose what you are comfortable with. Saying no is completely fine and has no effect.

How the photos and video may be used: Marketing for Rovix Dental Hub: websites, social media, recruiting and presentations.

Full name*

Role/job title*

Clinic name*

Email*

Training date*

Year

Month

Day

Training type*

Virtual

In person

Please choose for each line

Photos of me may be taken and used*

Agree

Disagree

Video of me may be recorded and used*

Agree

Disagree

I consent to be interviewed*

Agree

Disagree

My first name and job title may appear with my photo or video*

Agree

Disagree

If you disagree to photos or video: In person: you will be given a sticker to wear on your chest, near your collar, so we will not film you. Virtual: you may turn your camera off during any recording. If you appear by accident, that image will not be used or you will be blurred.

Changing your mind: You can change or withdraw your consent at any time by telling us in writing at connect@rovixdentalhub.com. New use stops once we receive it. Anything already posted will be taken down where possible, but printed materials already handed out cannot be recalled.

Signature*

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Date*

Year

Month

Day

Rovix Dental Hub – Training Agreement for Henry Schein Client Clinics

To be completed by the clinic owner or manager.

Owner/manager full name*

Title*

Clinic name*

Clinic city and province*

Email*

Phone*

Training date*

Year

Month

Day

Training type*

Virtual

In person

Read each statement and check to agree

1. Authority. I am the owner or manager of this clinic and I am authorized to agree to these terms on its behalf.

2. Henry Schein coverage. As a Henry Schein client, Henry Schein covers the first 2 hours of training. Any training time beyond 2 hours is the clinic's responsibility to pay.

3. Rate. Additional training time is billed at $350/hour (CAD), plus applicable taxes, in 30-minute blocks.

4. Approval before extra time. Training will not go past 2 hours unless the owner or manager approves the extra time at the session.

5. Payment. Rovix Dental Hub will invoice the clinic after the training. Payment is due within 15 days.

Signature*

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Date*

Year

Month

Day