PRE WORKSHOP WAVIER:
Release of Liability, Promise Not to Sue, Assumption of Risk, Agreement to Pay Claims and to Maintain Confidentiality
Name
First Name
Last Name
Email
example@example.com
Workshop to be attended:
PLEASE READ CAREFULLY. YOUR SIGNATURE BELOW WILL INDICATE YOU AGREE TO THE FOLLOWING: ASSUMPTION OF RISK: I understand that the Workshop is physically, emotionally and mentally demanding because the hours are long, the content is very intense and some participants may use profanity, express disturbing perceptions, emotions or experiences. I understand that not all of the risks associated with the group activities occurring during the Workshop are known or predictable because of the diverse backgrounds, temperaments and other individual characteristics of the participants. I understand and acknowledge that I have carefully assessed by own physical, emotional mental strength and endurance and have after careful deliberation concluded that I am able to and wish to participate in the Workshop. I understand and acknowledge that there are psychological, emotional and even physical risks to me and I knowingly and voluntarily assume all of those risks. INITIAL HERE:
NO REPRESENTATIONS OR WARRANTIES: I understand and agree that any information communicated to me by any person(s) who attended the Workshop is a matter of their experiences and opinion only. I agree that COR and COR Florida Community, LLC., its employees, officers, directors, facilitators, volunteers and agents (collectively, COR or “COR Florida Community”) are not and shall not be responsible for any representations so made. I understand and agree that COR and COR Florida Community makes no assertions, statements, guarantees or warranties regarding the contents of the Workshop. INITIAL HERE:
RELEASE: Specifically and forever release and discharge, and promise not to sue, COR and/ or COR Florida Community from any and all actions, causes of action, obligations, costs, expenses, attorney’s fees, damages, losses, claims, liabilities and demands of whatsoever character, nature and kind known and unknown, suspected or unsuspected, predictable or unpredictable arising out of or related directly or indirectly to my participation in the Workshop whether such injuries are psychological, physical emotional or mental. INITIAL HERE:
ARBITRATION: I agree to have any claim, controversy or dispute relating to the enforcement or interpretation of this document or arising or relating to my registration, participation or attendance at the Workshop submitted to binding arbitration under the rules and regulations of the American Arbitration Association in San Francisco, California. I do hereby waive my right to bring an action before a judge or jury in any court and I understand that I am giving up my rights to discovery and appeal. Any award rendered in any arbitration may be made a judgment by any court of competent jurisdiction. I understand that if I refuse to submit to arbitration after agreeing to this provision I may be compelled to arbitrate under the authority of the California Code of Civil Procedure. INITIAL HERE:
CONFIDENTIALITY/NON-DISCLOSURE OF MATERIALS: I understand that it is important for me to protect the privacy of other participants in the Workshop and therefore agree that I will not disclose the names or other means of identification of any other participant in the Workshop to any third party. I understand that the processes and materials of the Workshop belong to COR and are proprietary. My exposure to these processes and materials does not give me ownership in them and I understand that disclosure to third parties would cause economic damage to COR and COR Florida Community. Therefore I agree that I will not directly or indirectly disclose any details of the Workshop processes or materials to anybody. INITIAL HERE:
PERMISSION TO LEAVE WORKSHOP: I understand that I shall have the unequivocal right at any point in time during the Workshop even in the middle of an activity to end my participation in the Workshop and leave the premises. However, I understand that this is a residential workshop and as a participant, I am requested to remain on property for the duration of the workshop and by leaving, even if I return, I forfeit my place in the Workshop and the tuition I have paid. I will under no circumstances be entitled to a refund or return of any portion of the fees paid or the expenses I have incurred in attending the Workshop including, without limitation, my travel expenses to and from the Workshop. INITIAL HERE:
RIGHT TO EJECT: I agree not to engage in any conduct that may disturb, disrupt or prevent COR, or COR Florida Community, or the participants of the Workshop from delivering or participating in the Workshop. I understand and agree that in the event I do engage in any such conduct, COR and COR Florida Community shall have the right to instruct me to leave the Workshop and I agree to leave the Workshop if so instructed. I hereby grant COR and COR Florida Community the authority and the right to eject me from the Workshop if I refuse to leave after being so instructed. If instructed to leave or ejected I will not be entitled to a refund of any portion of the fees paid or the expenses I have incurred in attending the Workshop. INITIAL HERE:
PSYCHOTHERAPY. Choose the option below that applies to you
I am not at the present time in any form of psychotherapy
I am at the present time in some form of psychotherapy
I understand that the Workshop is not designed or delivered in such a way as to be psychotherapeutic. I hereby release COR and X from any and all liability for any adverse effects the Workshop experiences may have on me or on my course of psychotherapy. INITIAL HERE:
I acknowledge that during or after the course of the Workshop, the facilitators may refer me to certain professionals. It is my decision whether or not to obtain the services of these certain professionals. I accept all responsibility for my association with certain professionals and agree that in no way shall I seek to hold COR or COR Florida Community liable for any injury, claim or right of action arising out of my association with certain professionals referred to me by COR or COR Florida Community. INITIAL HERE:
This document contains all of the agreements and understandings between the parties and no representations other than those contained herein have been relied upon by any of the parties. I understand that this document is written to be as broad and inclusive as legally permitted. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms. INITIAL HERE:
I hereby acknowledge that I have carefully read and that I understand the terms and conditions of the above agreements. Unless I otherwise agree in writing to the contrary prior to the commencement of the Workshop, I understand that the terms of this document will be binding at all times during and after the Workshop.
Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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