I, the undersigned, hereby agree to the following:

 

 1. That I am participating in (Refuel You, Caregiver’s ) Retreat offered by Hearts for Healing, Inc. I recognize that this retreat/event may require physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

 

2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Retreat. I represent and warrant that I am physically fit and I have no medical conditions that would prevent my full participation in the Retreat.

 

3. I understand that if I am pregnant, I will take necessary steps to ensure my doctor and health care providers know I am participating in this Retreat. I assert that I am of fit health to participate in the Retreat and will alert all potential teachers whose sessions I participate in that I am pregnant.

 

 4. In consideration of being permitted to participate in the Retreat, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the retreat, including any and all activities done with the Retreat group, or as an individual at Camp Eagle, Cedar Bluffs, Nebraska.

 

 5. In further consideration of being permitted to participate in the Retreat, I knowingly, voluntarily and expressly waive any claim I may have against Hearts for Healing, Inc its staff, employees, or agents for injury or damages that I may sustain as a result of participating in the retreat. I, my heirs and legal representatives forever release, waive, discharge and covenant not to sue Hearts for Healing, Inc, it’s staff, employees, or agents for any injury or death caused by their negligence or other acts.

 

Signature of Participant / Parent or Guardian (if under 18) :