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Audio/Visual and General Liability Waiver

CONSENT & RELEASE FORM

“I take full responsibility for my experience”

I voluntarily consent to participate in the Awakened Living Project at New Eden.  I understand my stay is not intended to treat, cure, or heal any disease, mental illness or symptom, and is educational and/or recreational in nature.

I am responsible and accountable for my decisions, actions and results in life, and choosing to stay at New Eden for an experience powered by Heart iQ, I agree not to attempt to hold Christian Pankhurst, the Heart iQ Network, New Eden or any of its event organizers or facilitators liable for any decisions, actions or results that I make or experience in business or in life due to my my stay at New Eden at any time, under any circumstance.

I understand that sessions offered during my stay at New Eden may involve physical, mental, intellectual and emotional activity including exercises that may tax my physical, intellectual, mental and emotional capacity.  I understand and acknowledge that my participation in the sessions and in every separate part of it is purely voluntary, and that at all times I will be free to choose NOT to participate in any part or all of the sessions.  I acknowledge my responsibility for exercising my own judgment and initiative in choosing what parts I will participate in.  I acknowledge that my choices and my actions may pose a risk of injury to myself or others.  By this consent I knowingly and voluntarily assume that risk of injury either to myself or caused to others by me in the session.  I release Christian Pankhurst, the Heart iQ Network, New Eden, or any event facilitator or organizer from any and all liability for injuries to myself and for any injury to others caused by me. 



Confidentiality:  As a guest at the Awakened Living Project, I will not repeat other participants’ names or specific information shared in any facilitated session. I agree to respect the confidentiality of others, as I would want them to respect mine.  

Audio Visual Release:  By staying at New Eden, I understand that I may be photographed and/or audio/video-recorded for use by the New Eden and the Heart iQ Network. I agree that New Eden and the Heart iQ Network has the right and permission to use and publish such media - which may include my name, likeness, voice, city/state of residence, or photograph - for any purpose in any format, online (including, but not limited to, heartiq.org and neweden.org) and/or offline, now and hereafter without further compensation, permission, or notification. I understand that all official recordings from the event are the exclusive property of New Eden and the Heart iQ Network, available under the Creative Commons Attribution-ShareAlike license for general use, and I do not ask for nor expect compensation or notification of the use of official recordings or photographs in which I appear or speak.

I have read and understand this agreement fully and agree to be legally bound by it.  My signature below constitutes my acceptance of the conditions expressed in this agreement, and I agree to hold harmless and release from all liability: Christian Pankhurst, the Heart iQ Network, New Eden and any event facilitator or organizer.

First Guest's Name

First Name*

Last Name*

Phone*
First Guest's Date of Birth*
First Guest's Signature*
Second Guest's Name

First Name*

Last Name*
Second Guest's Date of Birth*
Third Guest's Name

First Name*

Last Name*
Third Guest's Date of Birth*
Fourth Guest's Name

First Name*

Last Name*
Fourth Guest's Date of Birth*
Fifth Guest's Name

First Name*

Last Name*
Fifth Guest's Date of Birth*
Sixth Guest's Name

First Name*

Last Name*
Sixth Guest's Date of Birth*
Seventh Guest's Name

First Name*

Last Name*
Seventh Guest's Date of Birth*
Eighth Guest's Name

First Name*

Last Name*
Eighth Guest's Date of Birth*
Ninth Guest's Name

First Name*

Last Name*
Ninth Guest's Date of Birth*
Tenth Guest's Name

First Name*

Last Name*
Tenth Guest's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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