Indemnity Waiver Form
Please fill out the following form to acknowledge and accept any potential risks involved and release liability.
Full Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Activity/Event Name
Acknowledgement
*
I acknowledge that workshops offered by the Provider may cover a range of topics including but limited to, mind-body wellness, parenting, separation and divorce, elder care, mental health and peer support. I understand that these workshops are for informational, educational, and support purposes only and do not replace professional medical, legal, or psychological advice.
I understand that these workshops are a safe place to share ideas and thoughts and that all personal information shared by myself and/or other participants during the workshop shall remain confidential. I agree to maintain confidentiality regarding discussions and ther participants' personal information.
I understand that participation in the workshop is voluntary.
I understand that the Provider will not disclose any personal details without consent, except as required by law.
I understand that the Provider is not responsible for personal decisions or outcomes resulting from the workshop.
I assume all risks associated with participation and release the Provider from any liability for personal injury, loss or damage during the workshop.
I understand that for workshops involving physical activity (e.g., yoga, meditation),I am responsible for my own physical well-being and should consult a physician before participating if needed.
I agree to engage with respect and kindness in all workshop activities.
Signature
*
Submit
Submit
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