Soul Tribe Heals' Emergency Contact & Release of Liability Form Logo
  • Soul Tribe Heals Retreats

    Pleas take a moment to fill out this form - thank you.
  •  -
  • Emergency Contact

    Please list the names and phone numbers of Emergency Contacts
  •  -
  •  -
  • Photo & Video Release

  • During this training, we take photographs of the participants in order to share the amazing vibes and updates. Some photographs and videos may capture your participation, directly or indirectly.

    These photos and videos may be published through our website and social media pages.

    With this, we seek for your consent in allowing us to publish photos and vidoes which may involve your images to the said platforms.

    Please do provide your response by selecting your choice below and submitting this form:

  • Disclaimer & Waiver of Liabilities

  • Disclaimer: Ancestral Healing Practitioners are NOT Medical Doctors (MDs). Ancestral Healing Practitioners are trained specialists who use non-invasive holistic practices to create a healthy environment for the mind, body and spirit. 

    I authorize Soul Tribe Group, LLC to develop a natural, complementary health improvement program for me in order to assist me in improving my overall health and not for the treatment or “cure” of any disease. 

    I understand that the experiences, excursions and services rendered are safe, non-invasive, Ancestral methods of balancing the body’s physical, emotional, and nutritional needs and those imbalances can cause or contribute to various health problems. 

    Nothing said, done, typed, printed or reproduced by Soul Tribe Group, LLC is intended to diagnose, prescribe, treat or take the place of a licensed physician. 

    I am a willing participant in Soul Tribe Groups, LLC’s Retreats

    I understand Soul Tribe Group, is a facilitator of Retreats and it connects Practitioners to Ancestral Healthcare providers. 

    I will act with integrity by being on time, clean, properly dressed, and respectful in sessions. 

    I will demonstrate the appropriate behavior for the safety and respect of everyone. 

    I will not attend any provider sessions/excursions while under the influence of drugs or alcohol. 

    I will obey the rules established by each provider. 

    I understand that Soul Tribe Group, LLC or any of it subsidiaries, contractor or employees are not liable for my healthcare, wellness or well being. 

    I understand that if I do not abide by these guidelines I will be removed from the program. 

    In consideration for receiving permission to participate in the Indigenous Womb Healing, Herbalism & Ceremony program provided by Soul Tribe Group, LLC, I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Soul Tribe Heals, LLC or any of it subsidiaries, contractor or employees from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while participating in such program, while in, on or upon the premises where the activities are being conducted, REGARDLESS OF WHETHER SUCH LOSS IS CAUSED BY THE NEGLIGENCE OF THE RELEASEES, or otherwise and regardless of whether such liability arises in tort, contract, strict liability, or otherwise, to the fullest extent allowed by law. 

    I am fully aware of the risks and hazards connected with the activities of Soul Tribe Group, LLC's Retreats including the Indigenous Womb Healing, Herbalism & Ceremony Program and Ancestral Practices and I am aware that such activities include the risk of injury and even death, and I hereby elect to voluntarily participate in said activities, knowing that the activities may be hazardous to my body and my property. 

    I understand that Soul Tribe Group, LLC does not require me to participate in these activities. I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, including death, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such activities, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise, to the fullest extent allowed by law.

    I further hereby agree to INDEMNIFY AND HOLD HARMLESS the RELEASEES from any loss, liability, damage, or costs, including court costs and attorney’s fees that Releasees may incur due to my participation in said program and activities, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise, to the fullest extent allowed by law. 

    It is my express intent that this Waiver and Hold Harmless Agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assignees and personal representative(s), if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT TO SUE Soul Tribe Group, LLC or any of its affiliates, employees, contractors and volunteers.

    I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Louisiana and that any mediation, suit, or other proceeding must be filed or entered into only in Louisiana and the Federal or State courts of Louisiana. Any portion of this document deemed unlawful or unenforceable is severable and shall be stricken without any effect on the enforceability of the remaining provisions. 

    In signing this document, I ACKNOWLEDGE AND REPRESENT THAT I HAVE READ AND UNDERSTAND THE FOREGOING WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT and that I am signing it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least Eighteen (18) years of age and fully competent; and I execute this Agreement for full, adequate and complete consideration fully intending to be bound by same. 

  • Clear
  • Should be Empty: