WAIVER AND RELEASE OF LIABILITY

WAIVER AND RELEASE OF LIABILITY

I ACKNOWLEDGE THAT I am able to walk around and move with ease.

IN CONSIDERATION OF my desire to share information during conversation sessions with (Your Company Name) (hereinafter referred to as the “Activity”);

I HEREBY, for myself, my heirs, executors, administrators, assigns or personal representatives (hereinafter collectively, “Releasor,” “I,” or “me”), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity; and

I HEREBY release and forever discharge (Your Company Name), their affiliates, managers, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (collectively “Releasees”), from any psychological injury that I may suffer as a result of my participation in the aforementioned Activity.

I AM VOLUNTARILY PARTICIPATING in the aforementioned Activity and I am participating in this Activity, which may include, but are not limited to: psychological injury, pain, suffering and emotional loss. I understand that these injuries or outcomes may arise from my own or others’ negligence. I assume all related risks, both known and unknown to me, of my participation in this Activity.

I AGREE that Releasees will not be held responsible for any injury or omission following the application of (Your Company Name)’s programs. 

I ALSO AGREE that none of the employees of (Your Company Name) is a licensed therapist. I agree that compassionate feedback provided by (Your Company Name) shall not be construed as professional counseling advice. 

I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney’s fees and related costs.

I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Releasees.

I HEREBY ACKNOWLEDGE that I have carefully read this WAIVER AND RELEASE OF LIABILITY and fully understand that it is a release of liability. I expressly agree to release and discharge (Your Company Name) and all of its affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, from any and all claims and causes of action and I agree to give up or waive any right that I otherwise have to bring legal action against (Your Company Name) for personal injury.

This WAIVER AND RELEASE OF LIABILITY shall remain in effect for the duration of my participation in the Activity, during this initial and subsequent event of participation.

Name of Participant:

Signature: ___________________________________ Date:

OR

Name of Participant’s Authorized Representative:

Signature: ___________________________________ Date:

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