Consent Form

Name

First Last

I hereby release and hold harmless Awakening Women, Inc., (AWI), and all teachers, staff, and volunteers from any and all legal liability for all claims, accidents, illness, injury, loss or other misfortune suffered by my person or property arising out of or connected with my participation and/or use of any services, equipment or facilities provided by AWI or their associates. (Required)

I understand and acknowledge that I am responsible for determining the extent to which I can safely participate in the retreat: physically, emotionally, mentally and spiritually. I assume full responsibility for my own safety and well-being and for the protection of my personal property. (Required)

In the event of an accident or serious illness, I hereby authorize AWI to obtain medical treatment for me and on my behalf. I hereby hold harmless and agree to indemnify AWI from any claims, causes of actions, damages and/or liabilities resulting from said injury or illness.(Required)

I hereby grant AWI permission to use likeness in photographs, video recordings or electronic images in any and all of its publications, including website entries, for purposes of publicizing and promoting AWI’s programs. (AWI is committed to being sensitive with the use of photos, and will remove any image you are not happy with.) (Required)

I, the undersigned, understand that AWI has the right, at any time, either before or during the retreat, to expel a participant if there is a breach of the instructions and guidelines of the retreat, and that in this case there is no right for refund of participation fee. In case I cancel my participation, I understand that the AWI Cancellation Policy is binding. (Required)

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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