Gnarly Roots Wellness - Annual Participant Packet

Gnarly Roots Wellness - Intake

At Gnarly Roots Wellness, we believe healing, growth, and self-discovery are not reserved for a select few. Connection is at the heart of everything we do, with yourself, with others, and with experiences that remind you you're capable of more than you imagined. It's not therapy. It is learning to fly.
Welcome to Gnarly Roots Wellness

Thank you for registering for a guided wellness experience. This packet must be completed before participation.
Which journey have you selected to begin?

Healing Intention: What are you hoping to experience? What inspired you to join?
Name

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Address

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Phone Number
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Birthday

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Emergency Contact

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Emergency Contact Phone Number
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Emergency Contact Relationship
Are there any accommodations or considerations that would help you participate safely?
List any medical conditions and/or medications
Insurance Company (emergency use only)
Member ID (emergency use only)

Wellness Disclosure
Please read this document carefully before participating.

Nature of the Experience
Gnarly Roots Wellness is a community built around meaningful experiences that help people reconnect with themselves. Through movement, creativity, mindfulness, education, and shared experiences, we create opportunities to better understand our minds, bodies, and the stories we've carried through life.

These experiences are educational and wellness-focused and are not psychotherapy, counseling, medical treatment, or crisis intervention.

I understand that:

No mental health diagnosis will be provided.
No psychological assessment will be completed.
No psychotherapy or counseling services are provided during these experiences.
Clinical therapy, assessments, supervision, and other professional services must be scheduled separately, with another provider.

Participation is voluntary.

Safety First!
Weather, Trail Conditions, and Event Modifications
Participant safety is the highest priority of Gnarly Roots Wellness.

Gnarly Roots Wellness reserves the right to postpone, reschedule, relocate, shorten, modify, or cancel any wellness experience due to weather, outdoor conditions, park closures, environmental hazards, facilitator illness, equipment issues or any other circumstance that may affect participant safety.

If an event is postponed or canceled by Gnarly Roots Wellness, participants will receive notification as soon as reasonably possible and will be offered the opportunity to transfer their registration to a future event or receive a refund in accordance with the current cancellation policy.

Participants acknowledge that conditions and public areas are unpredictable and that itinerary, route,location and duration may change for safety reasons. Gnarly Roots Wellness cannot guarantee the condition of trails, facilities, wildlife, vegetation, weather, outcomes with other contracted experience guides or the actions of other members of the public using these areas.

I certify that I am physically able to participate in this activity.

I understand it is my responsibility to:
- Wear appropriate footwear and clothing.
- Bring sufficient water.
- Dress appropriately for weather conditions.
- Monitor my own physical condition throughout the event.
- Notify the facilitator immediately if I experience pain, injury, illness, dizziness, or any condition affecting my ability to continue safely.
- I understand that I may stop participating at any time.
- Not use any mood or mind altering substances.
Follow all safety instructions provided by the facilitator.
Refrain from participating while under the influence of alcohol or illegal drugs.

I understand that participating in wellness activities involves inherent risks that cannot be completely eliminated.

These risks may include, but are not limited to:
- Uneven terrain
- Slips, trips, and falls
- Rocks, roots, mud, wildlife or other trail hazards
- Pulled muscles and stretching
- Fire exposure; burns
- Falls from aerial equipment
- Emotional engagement and trauma responses
I voluntarily choose to participate and knowingly assume all risks associated with participation.

Release of liability

To the fullest extent permitted by applicable law, I voluntarily release, waive, and hold harmless Gnarly Roots Wellness LLC, Brandy Taylor, its employees, contractors, volunteers, guides and representatives from any claims, demands, damages, losses, liabilities, costs, or expenses arising out of or related to my participation in a Gnarly Roots Wellness experience, except where caused by gross negligence or willful misconduct.

This includes, but is not limited to, claims arising from:
- Personal injury or death
- Illness
- Accident
- Falls
- Property damage or Loss of personal belongings
- Delays, cancellations, or changes due to weather or trail conditions
Medical or Mental Health Emergency Authorization

In the event of a medical or mental health emergency, I authorize Gnarly Roots Wellness to contact emergency medical services and my listed emergency contact.

I understand that I am financially responsible for any medical evaluation, treatment, transportation, or emergency services I receive.

Gnarly Roots Wellness experiences are educational and wellness-focused and are not intended to provide crisis intervention or emergency mental health care.

I understand and agree. By signing below I acknowledge my agreement.
Signature

Our Community Commitment
At Gnarly Roots Wellness, we believe nature belongs to everyone.

We welcome participants of all backgrounds, identities, life experiences, beliefs, abilities, races, ethnicities, sexual orientations, gender identities, ages, religions, and cultures.

We recognize that every person comes to the trail carrying different experiences. We ask each participant to approach one another with curiosity, kindness, and compassion.

By participating, I agree to:
- Treat every participant with dignity and respect.
- Honor personal boundaries.
- Respect differing life experiences and perspectives.
- I understand that behavior that threatens the safety or well-being of others may result in my removal from the event without refund.
I understand and agree. By signing below I acknowledge my agreement.

Photographs
Do you allow photos/videos to be used by Gnarly Roots Wellness for marketing/social media?
Cancellations

Participant cancellations 72 hours or more before the event: full refund or credit.

Participant cancellations less than 72 hours before the event: no refund, except in emergencies at the discretion of Gnarly Roots Wellness.

If Gnarly Roots Wellness cancels due to weather or safety concerns, participants may choose a full refund or transfer their registration to another experience.

Acknowledgment

By signing below, I acknowledge that:

I have carefully read this agreement and understand its contents.
I have had the opportunity to ask questions.
I voluntarily agree to participate at my own risk.
Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty:

Gnarly Roots Wellness - Intake

Welcome to Gnarly Roots Wellness

Wellness Disclosure

Please read this document carefully before participating.

Safety First!

Weather, Trail Conditions, and Event ModificationsParticipant safety is the highest priority of Gnarly Roots Wellness.

Our Community Commitment

Weather, Trail Conditions, and Event Modifications
Participant safety is the highest priority of Gnarly Roots Wellness.