ACCIDENT WAIVER AND RELEASE OF LIABILITY, RISK AGREEMENT MEDIA CONSENT AND RELEASE FORM

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH the RETREAT Deep Healing of the Goddess Within, held from Saturday,  May 2nd, 2020 through Saturday, May 9th 2020, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

I certify that I have not been advised to NOT participate by a qualified medical or mental health professional. I also certify that there are no health-related reasons or problems which preclude my participation in these activities.

I understand that all participation in this retreat is by choice and that I may exercise the option to not participate in any aspect of this program (physical, cognitive, or emotional) if in my judgment I determine that I may be at risk or unable to participate for any reason.In the event of an accident or emergency that renders me unable to communicate (or as the parent of a minor who cannot be contacted), I grant my permission for any medical care, operations, and charges which might become necessary.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity.

In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

(A) I WAIVE, RELEASE, ACCEPT FULL RESPONSIBLITY AND DISCHARGE from any and all liability and hold harmless, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my behavior, and for all risk of injury, illness, death, loss of personal property, and expenses thereof, as a result of my negligence, or other risks, including but not limited to those caused by physical obstacles, transportation, the terrain, weather, my emotional and physical condition, and other participants for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: Deep Healing of the Goddess Within Retreat and/or their directors, officers, employees, volunteers, good Samaritan first aid workers, representatives, and agents, and the activity holders, sponsors, and volunteers;

(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.

I acknowledge that the Retreat and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf.

I understand while participating in any or all activities, I may be photographed or videoed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, organizers, and assigns. I hereby authorize and grant my irrevocable permission and consent.

The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY, ASSUMPTION OF RISK AGREEMENT AND MEDIA CONSENT AND RELEASE FORM. I SIGN OF MY OWN FREE WILL AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Participant’s Signature ________________________________

Date __________________

Age ___________________

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