Innovia Life Membership with Healthier Texas

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Are you registering for one or more minors? *

Yes

If yes, please include the minor's full name, birthdate, and email address. Completion of this form is providing consent for adolescent support services as the parent or legal guardian.

What are some areas that you would like support with, or would like to learn more about? *

Subscriber Enrollment Agreement This Services Agreement (the “Agreement”), effective on this date is between you (hereinafter referred to as “Subscriber”), and Innovia Behavioral Health, LLC, and its affiliates and subsidiaries, including Innovia GA, LLC, with its principal office at 8735 Dunwoody Place #4315, Atlanta, GA 30350 (hereinafter referred to as “Company”). WHEREAS, Subscriber finds that the Company is willing to perform certain work hereinafter described in accordance with the provisions of this Agreement; and WHEREAS, Subscriber acknowledges that Company provides behavioral health maintenance and support and is not a substitute for treatment of any kind; and WHEREAS, Subscriber finds that the Company is qualified to perform the work, all relevant factors considered, and that such performance will be in furtherance of Subscriber’s requested services. NOW, THEREFORE, in consideration of the mutual covenants set forth herein and intending to be legally bound, the parties hereto agree as follows; 1. SERVICES. 1.1 Services to Subscriber. The Company shall provide the following educational, experiential, and therapeutic support group services (“Services”) to Subscriber: a. Subscribers gain access to an unlimited number of scheduled groups that are provided by the network of practitioners on Company’s calendar digitally via the membership platform or any other available outlet. This can be chosen from the group events and calendar posted on the platform and attended at-will. 2. PAYMENT TERMS. 2.1 Payment for Services. The Company will be paid as follows: a. Recurring monthly charges will be made to Subscriber’s credit card each month on approximately the same calendar day in accordance with the level that was subscribed to, unless your membership is sponsored by your employer or another organization, in this case Healthier Texas. 2.2 CANCELLATION. a. Subscriber may cancel at any time prior to the next monthly scheduled payment and understands there will be no prorated payments or refunds of any kind. b. If the Subscriber does not wish to cancel, this agreement will automatically renew each month. 3. ACKNOWLEDGEMENTS / INDEMNITIES. 3.1 Subscriber agrees and acknowledges that Company and its affiliates, employees or contractors have the right to refuse service to anyone who is deemed to be disrespectful to others while engaging in services or a threat to others or self in anyway. Anyone who is disruptive or unable to maintain respectful communication with others may be asked to leave, muted (via Zoom), removed (via Zoom), banned or have their subscription cancelled, at the sole discretion of Company and its affiliates, employees or contractors with just cause. 3.2 Subscriber acknowledges that Company is not providing any services that would be construed as treatment or therapy, nor is Company claiming to diagnose or treat any medical or mental condition. In the event of a need arises, Subscriber will be referred to applicable licensed treatment providers. Subscriber further agrees to indemnify, hold harmless and defend the Company, its affiliates, subsidiaries, shareholders, directors, employees, officers, contractors and agents from any and all claims of personal injury, economic loss, property damage, breach of contract, made by anyone that arises out of or is the result of the services provided under this Subscription Agreement, including for any minors named on this Agreement. 3.3 Subscriber acknowledges that in the event of an emergency, subscriber is to call 911 or call 988 for the mental health crisis line for immediate assistance. 4. WARRANTIES AND REPRESENTATIONS. The Subscriber warrants that it has the right, authority and power to enter into this Agreement and the Subscriber or an authorized representative has executed this Subscription Agreement. 5. NOTICE. All notices or other communications referenced under this Agreement shall be made in writing and sent to the address designated above, or designated from time to time in writing by the Parties. All notices shall be deemed given to the other party if delivered receipt is confirmed using one of the following methods; registered or certified first class mail, postage prepaid; recognized courier delivery; or electronic mail. 6. TERMINATION OF SUBSCRIPTION SERVICE. Unless otherwise agreed to, either party may terminate this Agreement at any time, with or without notice, subject to the terms and conditions stated herein in section 2.2 concerning cancellation of services. 7. WAIVER. No modification to this Agreement nor any failure or delay in enforcing any term, or requiring performance shall be binding or construed as a waiver unless agreed to in writing by both parties. 8. FORCE MAJEURE. Except for Subscriber’s obligation to pay the Company as provided herein, the Company shall not be liable for any failure to perform its obligations under this Agreement if prevented from doing so by a cause or causes beyond its control, including without limitation, acts of God and restraints of government. 9. GENERAL. This Agreement shall be governed by the laws of the State of Georgia. Except as otherwise specifically stated herein, remedies shall be cumulative and there shall be no obligation to exercise a particular remedy. If any provision of this Agreement is held to be unenforceable, the other provisions shall nevertheless remain in full force and effect. This Agreement may only be amended or modified by a writing signed by a duly authorized representative of each party. This Agreement will be executed electronically, and Subscriber and Company both agree to electronic signature. This Agreement replaces and supersedes any prior verbal or written understandings, communications, and representations between the parties regarding the subject matter contained herein. 10. PRIVACY. Subscriber information will never be shared with unaffiliated third parties without Subscriber consent, or unless ordered by a court of competent jurisdiction, or local, state, or federal officials regarding investigation. 11. SUCCESSORS AND ASSIGNS. This Services Agreement shall be binding on and inure to the benefit of the parties hereto and their respective heirs, administrators, executors, successors and assigns. 12. ASSIGNMENT. The Subscriber may not assign this Agreement without the Company’s prior written consent. I declare that I have read, understand, and accept the terms and conditions contained herein. © 2025 Innovia Behavioral Health, LLC and Innovia GA, LLC *

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