Indemnity Waiver Form

Indemnity Waiver Form

Please fill out the following form to acknowledge and accept any potential risks involved and release liability.
Full Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Activity/Event Name
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*
Should be Empty: