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Preparing to Die Program Participation & Waiver of Liability Agreement


Thank you for participating in the Preparing to Die online program presented by Andrew Holecek and guests.

By participating in the Program, you agree to the following terms and conditions:

Nature of the Program:

The information presented during the program, including ideas, suggestions, techniques, exercises, activities, instructions, and other materials (collectively, the materials), is educational and is provided only as general information and is not medical or psychological advice.

You understand that the Program is experiential and focuses solely on personal growth and spiritual exploration. It is not considered a treatment for any physical, emotional, or mental disorder. You agree to consult your healthcare providers for any specific medical, emotional, or psychological issues before the Program. Further, you agree to take full responsibility for your self-care during the Program and after.

Any stories or testimonials presented before or during the Program do not constitute a warranty, guarantee, or prediction regarding your experience during or after the Program. Further, you understand that the Forum of Living & Dying, LLC., makes no warranty, guarantee, or prediction that you will experience any particular state of awareness or consciousness during or after the Program, nor does it make any representation that you will experience a specific outcome on an issue.

Because the Program includes group processes in which you may voluntarily reveal personal information, you understand you waive your privacy and confidentiality rights. 

You acknowledge and agree that anything discussed with Andrew Holecek, independent contractors, and volunteers assisting with the program is merely a perspective for you to consider. You further understand that your participation in the Program is not intended to create nor does it establish a client-practitioner relationship between you and Andrew Holecek, or the independent contractors. If you elect to engage one of the independent contractors in a client-practitioner relationship, that is not a part of this program or waiver and will be covered by a separate agreement with that practitioner.

By participating in the Program, emotional or physical sensations may surface, which would be perceived as adverse side effects and possibly cause psychological and physical discomfort. If you experience any distressing reaction to participating in the Program, you agree to inform Andrew Holecek.

No Medical Care or Advice by Andrew Holecek or the Forum of Living & Dying, LLC: Andrew Holecek or the Forum of Living & Dying, LLC do not provide medical advice or care. Your interactions with Andrew Holecek are not intended to replace your relationship with your regular health care practitioners or primary care physician. Andrew Holecek or the Forum of Living & Dying, LLC do not recommend or endorse specific providers, tests, physicians, medications, products, or procedures. The content of the Site and the Services, including, without limitation, text, copy, audio, video, photographs, illustrations, graphics, and other visuals, is for informational purposes only and does not constitute professional medical advice, diagnosis, treatment, or recommendations of any kind by Andrew Holecek or the Forum of Living & Dying, LLC. You should always seek the advice of your qualified healthcare professionals with any questions or concerns you may have regarding your individual needs and any medical conditions. All information provided by Andrew Holecek or the Forum of Living & Dying, LLC, is intended for general information purposes only and is in no way intended to create a provider-patient relationship as defined by state or federal law.

Not for Emergencies: IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, YOU SHOULD DIAL “911” IMMEDIATELY. Andrew Holecek or the Forum of Living & Dying, LLC's Site and Services are not for medical emergencies or urgent situations. You should not disregard or delay seeking medical advice based on anything that appears or does not appear on the Site. If you believe you have an emergency, call 9-1-1 immediately. You should continue to consult with your primary provider and other healthcare professionals as recommended. Always seek the advice of a physician or other qualified healthcare provider concerning questions you have regarding a medical condition and before stopping, starting, or modifying any treatment or modification.

Waiver of Liability:

You represent that you are competent and able to understand the nature and consequences of participating in the Program and that you are an adult in the Country or State of your residence.

You understand that participating in the Program is strictly voluntary, at your own risk, and you freely choose to participate. Since the Program is experiential and the extent of the Program’s risks and benefits are not fully known, you agree to assume and accept full responsibility for any known and unknown risks associated with your participation in the Program, including any physical injury, psychological or emotional effects, death, loss or property damage.

You agree to release the Forum of Living & Dying, LLC, Andrew Holecek, independent contractors, and volunteers from any liability resulting from your participation in the Program. Expressly, you and your heirs agree to full release, indemnify, hold harmless, and defend the Forum of Living & Dying, LLC, Andrew Holecek, independent contractors, and volunteers from any claims or liability and for any damage or injury, including but not limited to, financial, personal, emotional, psychological, medical or otherwise, which you may incur arising at any time as a result of your voluntary decision to participate in the Program.

You further agree to hold harmless the Forum of Living & Dying, LLC, Andrew Holecek, independent contractors, and volunteers from any damages or costs, including Court and attorney’s fees, which may be incurred due to your participation in the Program.

This agreement shall constitute the complete understanding between the parties and shall supersede any prior or contemporaneous representations or agreements, oral or written. This agreement shall be interpreted under and governed by the laws of the State of Colorado. If any action at law or equity is brought to enforce any of the terms of this agreement, the prevailing party shall be entitled to actual attorney's fees and costs.  It is agreed that the venue for any such action at law is the City and County of Boulder, Colorado. No assignment of this agreement is permitted, and any attempt to assign all or any rights, obligations, or duties granted under this agreement shall be null and void.

By signing below, you acknowledge that you have carefully and thoroughly read and fully understood all aspects of this Agreement and agree to all of the terms and conditions stated herein.





First Participant's Name
First Name*
Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
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*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also 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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
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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