Participation Waiver & Release Form

Participation Waiver & Release Form

For In-Person Events and Services
While attending in person events and services can contribute to feelings of happiness, an increased sense of connection and greater processing and integration of material, attending events in person also comes with inherent risks. These can include (but are not limited to) falls and injury, lost or stolen property, damage to vehicles on the way to/from or while parked during the event, contracting illness, and death. Please carefully consider the risks when choosing to attend an in-person event.

Please note: events held at Tumwater Therapy Space are not fully accessible as the space is not ADA compliant.
Participant Name

First NameLast Name
DOB

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Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
MEDICAL RELEASE: In the case that I experience an actual or percieved medical emergency, as deemed necessary by Illuminated Encounters, LLC., I authorize Illuminated Encounters, LLC. to contact emergency services to procure assessment and proper medical care. I agree to accept all financial responsibility for medical services procured on my behalf by Illuminated Encounters, LLC., regardless of the results of services procured.
EMERGENCY CONTACT: In the case of emergency I authorize Illuminated Encounters, LLC. to contact my listed emergecy contact and to leave a detailed voicemail if necessary.
LIABILITY WAIVER: Even with the best of planning and precautions taken, unforseen events can occur when attending events in person. I am aware of the dangers of attending in-person services and events with Illuminated Encounters, LLC. I agree to assume and accept all risks and hazards inherent in attending on-site activities.

I promise not to hold Illuminated Encounters, LLC., its officers, agents, employees or descendants liable or pursue legal action against them. This waiver absolves the company of any duty for injuries sustained on the premises before to, during, or after the activity.

By signing this agreement, I agree to hold the company completely harmless, including financial responsibility for any injuries sustained, regardless of the cause or circumstances.

I will do all in my power to cooperate with staff requests and all safety requirements, and I will seek clarification if necessary.
Participant Signature

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