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Release Form & Waiver For All Events Hosted or Facilitated By:

Kriyanna Feyalove (Christine Theurer) &/OR 

Cedar Bear (Nicolas Samuel Florino) 

*Both names also referred to as 

(Above stated names)

 


By registering for and attending a event the participant understands and agrees to the following:

* The participant agrees that the use of all, or part, of the service is entirely at the participants own risk. Any actions or lack of actions, taken by the participant of such advice is done solely by choice and responsibility of the participant and is neither the responsibility nor liability of event organizers, facilitators, volunteers, or any person or organization associated with them and their activities.​​

* The participant understands that any experience, service and/or information at the event is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care or substance abuse treatment, and the participant will not use it in place of any form of therapy.

* The participant recognizes that the group process in the event requires emotional, physical, and mental efforts, exertion, and behavioral experimentation, on the participants part, which may cause physical, mental, or emotional stress. The participant fully acknowledges and takes full responsibility for all risks involved.

​* The participant understands that it is their responsibility to consult with his/her primary healthcare provider prior to participating and should the participant choose not to consult their healthcare provider, the participant accepts full responsibility waiving all rights to liability or any claims against above stated names and any of its associated members or parties.

​* The participant understands the contagious nature of the SARS-CoV-2 virus (the “novel coronavirus” or “COVID-19”) and voluntarily assumes the risk that they may be exposed to or infected by the novel coronavirus by attending and/or participating in the event, and that such exposure or infection may result in personal injury, illness, permanent disability, and/or death. The participant understands that their participation in the event involves the inherent risk of exposure to the novel coronavirus and you attend the event at your own risk and solely by your own choice alone.

​* It is suggested that the participant avoids engaging in the event while using mind/mood altering substances such as, but not limited to: cannabis, entheogens, alcohol, or certain prescription medications as they may increase/decrease the effectiveness of what is being offered. If the participant chooses to partake in any mind/mood altering substances, you do so at your own risk and by your own choosing.

​* Participant agrees to ask for help when you need it.

​* Classes and events are an opportunity for deep transformation and energetical activation. Some activities are NOT recommended for those who have experienced head injury, epilepsy, heart attack, seizures, stroke, PTSD or who have been diagnosed with bipolar disorder, or any such related conditions. Participant agrees to let the facilitator know if they have any such conditions BEFORE a class/event starts. If a participant has questions about attending an event due to a condition they will ask a facilitator.

* Participant understands photo and or video may be taken of them during the event and shared to promote this work. We will never share participants process or vulnerable moments. If participant does not want photo and or video taken of them we ask that you please talk to a facilitator and tell them on your own time. 

​* The above names of facilitators and its representatives reserve the right to refuse service to anyone for any reason at any time with no amount of refund given. The above stated names are also not responsible for any property loss or damage.

​* ​ Participant takes full responsibility for their participation. The participant and/or legal representatives forever release, waive, discharge, and covenant not to sue the above stated names, other facilitators, staff, or volunteers for any injury, illness, harm, life changing event, or death caused by either negligence or other act.

* Participant agrees to follow the guidance of the facilitators as the tools being offered may help one to heal and spiritually awaken, while also listening to their own inner guidance and truth.


​The participant has read and understood this form and all its content, and my signature below verifies that I am in agreement with all of the above.

 





First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Signature*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Signature*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

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

Email*

Confirm Email*
Check to be added to our email list for upcoming events and offerings!
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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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