INFORMED CONSENT AGREEMENT
A. CLIENT WAIVER OF LIABILITY
1. Assumption of Risk: In consideration of my participation in the classes, workshops, and/or website resources offered by Company, I understand and voluntarily accept and assume the risks associated with it, and agree that Company, its representatives, agents, and successors, and assigns will not be liable for any injury, including, without limitation: personal, bodily, or mental/emotional injury, economic loss or any damage to me, my spouse, guests, minor children, unborn children, or relatives resulting from the negligence of Company or anyone acting on Company’s behalf. In addition, I acknowledge that I have voluntarily applied to participate with the knowledge of the risks and dangers involved including but not limited to those involving mental and emotional stress, and physical harm or stress. I understand that Company does not guarantee any outcomes based on its classes and workshops given. I AGREE TO BE RESPONSIBLE FOR MY OWN WELFARE AND TO ACCEPT ANY AND ALL RISKS OF DELAY, UNANTICIPATED EVENTS, INCONVENIENCE, ILLNESS, INJURY, EMOTIONAL TRAUMA OR DEATH.
2. Indemnification: I assume full responsibility for my conduct. On behalf of myself, my heirs, executors and administrators further forever waives, releases and discharges any claims against Company, its affiliates, agents and employees, and assigns for any injuries or damages (including those for the rendering or failure to render first aid, medical treatment or other treatment or service) on account of, arising from, or in connection with the services provided by Company (including attorneys’ fees), and/or the use of Company’s courses, property, facilities, and/or equipment. This release expressly includes the assumption of risk and release of any claims for injuries or damages alleged to result from or arise out of any negligence by Company, its affiliates, agents and employees, and assigns, including, without limitation, premises liability claims. I agree to be fully responsible for any and all bills for medical services rendered to me, personal injuries, property damage, loss of personal property, and any other loss that may result.
3. Loss of Property: I understand and acknowledge that Company is not responsible for disappearance, loss, theft, or damage to, injury from, or unauthorized use of personal property, including money, negotiable securities, personal electronics, or jewelry left in the facilities during any class or workshop.
4. Professional Records and Confidentiality: All information discussed in the course of any class or workshop is strictly confidential, except for the confidential information noted below. I agree to keep all information heard or discussed during group sessions confidential. Unless prohibited by law, Company will only disclose confidential information if I, or a person legally authorized to consent on my behalf, has given express written consent. When possible, Company will inform the Client about the disclosure of confidential information and possible ramifications before the disclosure is made. Company must disclose certain confidential information as required by law or if the confidential information may put me or others at risk of harm or compromise their well-being. Company may use elements of my story in its future classes, workshops, and/or website but Company strictly agrees to keep my name and likeness anonymous.
B. LIMITATIONS OF AND DISCLAIMERS REGARDING THE PARTIES’ RELATIONSHIP. I understand and agree that I am participating in a workshop, class, and/or website put on by Company. I further understand and agree that advice provided during the class, workshop, and/or website is distinctly different from counseling, psychotherapy, psychoanalysis and similar services, and does not deal with the diagnosis or treatment of emotional problems. I understand and acknowledge that the Staff Members of Company are not licensed psychologists. I understand that this is not a substitute for medical or psychiatric treatment and is not recommended for people with serious psychiatric disorders. I also understand and agree that my participation and attendance does constitute medical consultation or treatment, and therefore health insurance does not apply.
C. MINIMUM AGE REQUIREMENT: The minimum age for Company’s classes and workshops is eighteen (18) years, and the Client agrees that Company will not be responsible for verifying that the Client is eighteen (18) years of age or older.
D. GENERAL PROVISIONS
1. Severability: If any provision of this Agreement or the application thereof to any person or circumstance shall be invalid, illegal or unenforceable to any extent, the remainder of this Agreement and the application thereof shall not be affected and shall be enforceable to the fullest extent permitted by law.
2. Waivers: The failure of any party to seek redress for violation of or to insist upon the strict performance of any covenant or condition of this Agreement shall not prevent a subsequent act, which would have originally constituted a violation, from having the effect of an original violation.
3. Waiver of Jury Trial: EACH PARTY, TO THE FULLEST EXTENT PERMITTED BY LAW, HEREBY IRREVOCABLY WAIVES ALL RIGHT TO TRIAL BY JURY AS TO ANY ISSUE RELATING HERETO IN ANY ACTION, PROCEEDING OR COUNTERCLAIM ARISING OUT OF OR RELATING TO THIS AGREEMENT OR ANY OTHER MATTERS INVOLVING THE PARTIES HERETO.
4. Assignment: Neither this Agreement nor any of the rights, interests or obligations hereunder shall be assigned by either party without the prior written consent of the other party; provided, however, that Lisa Jean Haskins LLC may, without notice to the Client, (i) assign this Agreement to any entity that acquires all or substantially all of its assets or its business that is the subject hereof, or (ii) assign this Agreement to any entity that is owned by Lisa Jean Haskins LLC.
5. Counterparts: This Agreement may be executed in counterparts, each of which shall be deemed an original, but all of which shall constitute one and the same instrument.
6. Headings: The Headings in this Agreement are inserted for convenience only and are in no way intended to describe, interpret, define or limit the scope, extent or intent of this Agreement or any provision thereof.
7. Entire Agreement: This Agreement constitutes the entire and exclusive agreement between Client and Company, and supersedes all prior promises, representations, understandings and/or agreements relating to Company’s actions, services and conduct of business.