Event Liability Waiver
Please read the event liability waiver in full.  By checking the box and clicking send, you are agreeing to the terms of the liability waiver.  
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Your Full Name  *
Phone number *
Your Email *
Your retreat location (city and state) *
Date of event *
List "other" name of event and event date
I agree to the liability waiver as written below *
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Liability Waiver
1. This event Liability Waiver ("Waiver") applies to the Flat Retreat weekend event ("Event") in which I am participating.  Please read the following information carefully before signing.

2. I, the event participant, hereby assume all of the risks of the participating and/or volunteering in this Event, including by way of example and not limitation, any risks that may arise from negligence on the part of the persons or entities being released.  I certify that I am physically fit to participate in this Event, and have not been advised to not participate by a qualified medical professional.

3. I acknowledge that this Waiver will be used by the Event holders, sponsors, and organizers of the Event in which I may participate, and that it will govern my actions and responsibilities at said Event.  In consideration of the event holders, sponsors, and organizers permitting me to participate in this Event, I hereby take action for myself and the individuals representing my interests as follows:
     3a. I WAIVE, RELASE AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this Event, THE FOLLOWING PERSONS: Flat Retreat LLC, Stacey Sigman and Teri Kincaid and any of its directors, officers, employees, volunteers, representatives and agents, as well as contracted facilitator, Event volunteers, sponsors and other participants.
     3b I INDEMNIFY, HOLD HARMLESS AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this EVENT, whether caused by negligence of said parties or otherwise.

4. I understand that at this Event and related activities, I may be photographed.  I acknowledge that this Event may occur in the public and/or in private.   I agree to allow my photo, video and/or film likeness to be used for any legitimate purpose by the affiliated parties, including publications.

5. The Waiver shall be construed broadly to provide release and waiver to the maximum extent permissible under applicable law.  I certify that I have read this Waiver, that I fully understand it's content, and that I agree to its terms.
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