Let’s work together

Name *

First Name

Last Name

Phone

(###)

###

####

Participant Age: *

1 - 2 Years Old

2 - 3 Years Old

3 - 4 Years Old

4 - 5 Years Old

5 - 6 Years Old

6 - 7 Years Old

Preferred Date of Participation *

MM

DD

YYYY

Participation Liability Waiver *

By checking the boxes below, you agree to itemized terms of the study.

The Legal Guardian willingly volunteers to join and participate in Engenium’s voluntary submission study.

*

The Legal Guardian is aware and acknowledges that Engenium will not be held responsible for the risk and hazard that may arise during this activity.

*

Engenium will not provide any compensation to the Party should a risk or hazard arise.

*

The Party expects no compensation, bonus and or reward for joining in the aforementioned activity beyond what has been provided.

*

There is no solicitation that the Company requires for the said activity. Therefore, the Party is responsible for their own budget and expenses during the activity.

*

Once your application is accepted, and the participant has completed all tasks, the Legal Guardian may be eligible for Zelle or Venmo incentive for submission of requirements. By checking the box, you agree to the above, and that the participant is not receiving compensation.

*

Engenium identifies that the potential risk of finger entrapment, tongue entrapment, laceration, and airway obstruction (choking) may have a potential to occur. The Legal Guardian is hereby aware that the product-participant interaction is to be supervised at all times. Exposure to the above mentioned or additional risks or hazards may occur.