In consideration of the opportunity to participate in the Wild Heart Society’s groups, retreats, camps, coaching and/or trainings made available through Wild Heart Society, herein referred to as "WHS," I agree as follows:
1. I understand and acknowledge that participation in groups, retreats, camps, coaching and/or trainings at WHS may be dangerous and may involve risks which include, but are not limited to, bodily injury, partial or total disability, paralysis and death. I also understand and acknowledge that the social and economic losses or damages which can result from those risks and dangers can be severe and that not all such risks and dangers may be known or reasonably foreseeable at this time. I accept the responsibility for losses or damages resulting from all such risks and dangers involved in participation in groups, retreats, camps, coaching and/or trainings at WHS.
2. I agree to take appropriate precautions for my own safety and that of others when participating in the program and further agree that, before participating I will inspect the facilities and equipment to be used and will, if I believe anything is unsafe, immediately advise a staff member at WHS of that unsafe condition(s) and will refuse to participate.
3. I hereby release, waive and discharge WHS, its owner, clinicians, practitioners, coaches and employees from all liability to me and to my conservators, guardians or other legal representatives, assigns, heirs and next of kin for any and all claims, demands, losses or damages on account of any injury, death or damage to property, arising out of my participation in groups, retreats, camps, coaching and/or trainings whether on WHS premises or elsewhere, including transportation of myself and/or my child to and from those venues.
4. If participating at an offsite event or venue, I assume responsibility for transportation of myself and/or my child(ren) to and from these events or venues.
5. I also hereby agree to indemnify and to hold harmless from any claim or demand on account of injury or damage which I may suffer as a result of participation in groups, retreats, camps, coaching and/or trainings WHS and all other persons mentioned in Paragraph 3.
6. I understand that this release, waiver and agreement to indemnify and hold harmless includes, but is not limited to, damages which are caused, or alleged to caused, in whole or in part by the negligence of WHS and the individuals listed in Paragraph 3.
I have read the above agreement of release and waiver of liability and understand that by signing it I have given up substantial rights. I sign this agreement voluntarily. I am the parent or legal guardian of the participant listed in my registration and/or intake paperwork, who is either myself or is under the age of 18 years, and who wishes to participate in WHS groups, retreats, camps, coaching and/or trainings. In consideration of Wild Heart Society allowing myself or my child to participate in groups, retreats, camps, coaching and/or trainings I hereby agree to indemnify Wild Heart Society and all other persons described in Paragraph 3 above, and to hold each and all of them harmless from any claim or demand on account of injury to or damage suffered by my child as a result of participation in groups, retreats, camps, coaching and/or trainings whether on Wild Heart Society premises or elsewhere.
I acknowledge it is my responsibility to deliver my child(ren) to the program and to pick up my child(ren) promptly upon the scheduled conclusion of groups, retreats, camps, coaching and/or trainings. If participating in an offsite event or venue, I assume responsibility for transportation of myself and/or my child(ren) to and from those events and/or venues. This agreement includes, but is not limited to, claims or demands on account of injury or damage caused or allegedly caused by the negligence of Wild Heart Society or any of the individuals listed in Paragraph 3. By signing below, I indicate I understand that this represents my electronic signature on this date.