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Governing Law and Jurisdiction Agreement
For Physician in Private Practice
Any blank space that is not fillable will be filled with the name of the Camp Agudah Doctor on duty and should be left blank.
This agreement ("Agreement") is entered into by and between
Name of Camper/staff or parent if camper/staff is under 18
and ______________________________ (collectively, the "Parties").
Governing Law
The parties hereby agree that:
a) all aspects of the relationship between
Name of patient
and ______________________________ as well as her/his agents, delegates, employees, and any physicians and other independent healthcare practitioners providing medical or other healthcare and treatment to
Name of patient
or in association with _____________________________ including without limitation any medical or other healthcare and treatment provided to
Name of patient
and
b) the resolution of any and all disputes arising from or in connection with that relationship, including any disputes arising under or in connection with this Agreement,
shall be governed by and construed in accordance with the laws of the province or territory of Ontario (other than conflict of laws rules) and the laws of Canada applicable therein.
Exclusive Jurisdiction
The Parties thereby acknowledge that the medical or other healthcare and treatment received by
Name of patient
from ______________________________ will be provided in the province of Ontario and that the Courts of Ontario shall have exclusive jurisdiction to hear any complaint, demand, claim, proceeding or cause of action, whatsoever arising from or in connection with that medical or other healthcare and treatment, or from any other aspect of the relationship between
Name of patient
and ____________________________________.
Date
*
MM slash DD slash YYYY
Name of patient
Signature of patient or parent if patient is a minor