I/We acknowledge and confirm that I/we have read and understood the informational material that has been provided about the Service by my/our Healthcare Professional, and have been given the full opportunity to discuss Metascreen with my/our Healthcare Professional and make an informed decision to obtain Metascreen.

I/We hereby consent to the performance of the Service by HKSC for my/our Child and the transmission of the urine sample and results by Cordlife to and from HKSC. I/We further understand and agree that the fees for the Service shall not be refundable in the event that the Service could not be performed in view of my/our failure to properly collect the urine sample or transmit the same to Cordlife for any reason whatsoever.

I/We have been informed that the analyses, conducted as part of the Service, produce results that can be used by qualified physicians in the diagnosis of disorders described in www.metascreen.org. I/We understand that the evidence of these conditions will be detected in the majority of affected individuals; however due to the age of the Child at time of collection of the Specimen, the quality of the Specimen, health status of the Child and other variables, such conditions may not be detected in my Child. I/We hereby release and hold free and harmless Cordlife, HKSC, my/our Healthcare Professional, the hospital or birthing center, and all their respective officers, directors, employees, agents, affiliates, successors and assigns from any and all liability for any and all loss, harm, damage or claim of any kind in connection with the collection, processing, testing, screening and transport of the Specimen and its results. In all other cases, I/we understand that the liability of Cordlife, HKSC, my/our Healthcare Professional, the hospital or birthing center, and all their officers, directors, employees, agents, affiliates, successors and assigns to me/us shall not exceed the amount of fees I/we have paid.

I/We further acknowledge and consent to a portion of the Specimen being used anonymously for research purposes and the findings thereof being used in research publications in compliance with all relevant laws and ethical guidelines. I/We further waive whatever rights, claims or interests which I/we may have over the Specimen of the Child, in full and complete support of the research.


(This Registration Form, Personal Information Collection Statement, Statement of Informed Consent and Release shall be written in English and may be translated to other languages. In any event of any discrepancy between the English and translated version, the English version shall prevail.)