I am aware of the dangers and risks to my person and property while participating in Amy Koss / Nourished Soul’s Nutrition Coaching Services, Reiki, Kambo, Ceremonies, Workshops, and Retreats (Provider) and as consideration for the right to participate in these services and activities, I, for myself, my heirs, executors, administrators, and/or personal representatives, knowingly and voluntarily enter into this waiver and release of liability.
I further acknowledge that the Provider is not a licensed medical doctor, registered dietitian, or certified medical professional, and any advice or guidance offered is not intended to diagnose, treat, cure, or prevent any disease or medical condition. I agree that any changes to their diet, physical activity, or wellness regimen should be done in consultation with their personal physician or a licensed healthcare provider.
I also understand that there are potential risks of which I may not presently be aware. Because of the dangers of participating in these services and activities, I recognize the importance and agree to fully comply with the applicable laws, policies, rules, and regulations, and any instructions regarding participation in these services and activities.
I understand that the Amy Payne Koss and/or Nourished Soul do not insure participants in the above-described services and activities, that any coverage would be through personal insurance, and that Amy Payne Koss and/or Nourished Soul has no responsibility or liability for injury resulting from this activity.
I voluntarily elect to participate in these services and activity with knowledge of the danger involved, and I hereby agree to accept and assume any and all risks of property damage, personal injury, and/or death.
Waiver of Liability and Indemnification:
In consideration for being allowed to voluntarily participate in the above-referenced services and activities, on behalf of myself, my personal representatives, heirs, executors, next of kin, administrators, successors and/or assigns, I forever: waive release, and discharge any and all rights, claims, or causes of action of any kind whatsoever arising from my participation in the above referenced services and activities, and do hereby release and forever discharge Amy Payne Koss and Nourished Soul, including its affiliates, officers, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, and predecessors, from any and all negligence, any physical or psychological injury, including but not limited to illness, death, personal injury, disability, damages, economic or emotional loss, that I may suffer as a direct result of my participation in these services and activities, including travel to and from any event related to these activities.
I agree to defend, indemnify, and hold harmless Amy Payne Koss and Nourished Soul, its agencies, officers and employees, from and against any and all claims of any nature including all costs, expenses and attorneys’ fees, which in any manner result from participant’s actions during any and all services and activities.
This release is intended to be as broad and inclusive as permitted by the laws of the state in which these services and activities are conducted.
I acknowledge that they have read and understand the provisions of California Civil Code § 1542, which states:
"A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor or released party."
I expressly waive the protections of California Civil Code § 1542, and release any and all claims that may exist, whether or not I currently know of or suspect such claims.
I understand that the Provider makes no guarantees, warranties, or representations of any kind concerning the results that may be obtained from using the Provider’s services. I acknowledge that results may vary based on individual circumstances, and I have not relied on any such promises.
I, the undersigned participant, affirm that I am at least 18 years of age and am freely signing this agreement. I have read this form and fully understand that by signing this form I am giving up legal rights and/or remedies which may otherwise be available to me regarding any losses I may sustain as a result of my participation. This Agreement constitutes the entire agreement between the Client and Provider concerning the subject matter hereof, and supersedes all prior negotiations, understandings, and agreements, whether written or oral. No amendment or modification of this Agreement shall be valid unless made in writing and signed by both parties. I agree that if any portion is held invalid, the remainder will continue in full legal force and effect.