INNER-GENIUS® Writing and Movement Workshops INFORMED CONSENT WAIVER AND RELEASE OF LIABILITY Assumption of Risks: Physical activity, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. Inner-Genius’s Writing and Movement Workshops may include yoga-type stretches, dance and coordination exercises, Tai Chi-type movements and other similar activities. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains to 2) major injuries such as eye injury or loss of sight, joint or back injuries and heart attacks. I understand, and appreciate that the activities and programs at the Inner-Genius Writing and Movement Workshop carry certain inherent risks, and I hereby assert that my participation is voluntary and that I knowingly assume all such risks. WAIVER OF LIABILITY AND INDEMNIFICATION: In consideration of permission to use, today and on all future dates, the property, facilities, staff, equipment, services, and programs of the Inner-Genius Writing and Movement Workshop, I, for myself, my heirs, personal representative or assigns, do hereby release, waive, discharge, and agree not to sue Inner-Genius, its owners, officers, agents, employees, and representatives (“Releasees”) from any and all liability for any harm, injury, damage, claims, demands of any kind, actions, causes of action, costs and expenses that I may have or that hereafter may accrue to me, arising out of any loss, damage, or injury, including death, that may be sustained by me or any loss or damage to any property belonging to me, whether caused by the negligence, misfeasance, or nonfeasance of Releasees or otherwise while in or upon premises or equipment of the Inner-Genius Writing and Movement Workshop or engaged in any activity or program offered at and by the Inner-Genius Writing and Movement Workshop. I also agree to INDEMNIFY AND HOLD Releasees HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees, that result from my participation in or involvement with any program or activity at or associated with the Inner-Genius Writing and Movement Workshop and to reimburse Releasees for any incurred expenses. I further agree to comply with the stated and customary terms and conditions of participation and agree that if any unusual or significant hazard is observed, my activities will be discontinued and I will immediately bring such matter to the attention of the nearest official. ACKNOWLEDGEMENT OF UNDERSTANDING: I have read this Agreement, fully understand its terms, and understand that it affects my legal rights. I am signing this Agreement knowingly and voluntarily, and intend for it to be a complete and unconditional release of liability to the greatest extent allowed by law. Please initial below: jd *
