RELEASE AND WAIVER OF LIABILITY, INDEMNITY AND MEDICAL RELEASE
In Consideration of participating in non-invasive practices and/or activities, for other good and valuable consideration, I hereby agree to release and discharge from liability arising from negligence The Healing Chamber and its owners, Directors, Officers, Employees, Agents, Volunteers, and all other person(s,) affiliates or entity(ies) acting for and/or on behalf of them (hereinafter referred to as “Release(es,)”) on behalf of myself, family(ies,)child(ren,) parents, heirs, assigns, representatives, and estate, and also agree as follows:
- I acknowledge that TheHealing Chamber, its subsidiaries and its and/or any of its affiliated is NOT a Medical Facility. The Healing Chamber has trained specialists who use non-invasive practices to create a healthy environment for the mind, body and spirit. I am a willing participant in The Healing Chamber's program.
- I authorize The Healing Chamber to perform services to develop a holistic, complementary health improvement program for me in order to assist me in improving my overall health and not for the treatment or “cure” of any disease.
- I understand that the services rendered are safe, non-invasive methods of balancing the body’s physical, emotional, and nutritional needs and those imbalances can cause or contribute to various health problems.
- I understand that I should continue to see any medical doctors I am currently under the care of, and that any prescription medication should not be altered without first consulting the Doctor who recommended it.
- Nothing said, done, typed, printed or reproduced by The Healing Chamber is intended to diagnose, prescribe, treat or take the place of a licensed physician.
- I will act with integrity by being on time, clean, properly dressed, and respectful in sessions.
- I will demonstrate the appropriate behavior for the safety of everyone.
- I will not attend any provider sessions while under the influence of drugs or alcohol.
- I will obey the rules established by each provider
- I understand that The HealingChamber is not liable for my healthcare.
- I understand that if I do not abide by these guidelines I will be removed from the program.
- I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE The Healing Chamber and its Owners, Directors, Officers, Employees, Agents, Volunteers, and all other person(s,) affiliates or entity(ies) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while participating in such activity, while in, on or upon the premises where the activities are being conducted, REGARDLESS OF WHETHER SUCH LOSS IS CAUSED BY THE NEGLIGENCE OF THE RELEASEES, or otherwise and regardless of whether such liability arises in tort, contract, strict liability, or otherwise, to the fullest extent allowed by law.
- I am fully aware of the risks and hazards connected with the activities of treatments and practices and I am aware that such activities include the risk of injury and even death, and I hereby elect to voluntarily participate in said activities, knowing that the activities may be hazardous to my body and my property.
- The herbs and nutritional supplements that have been recommended are traditionally considered safe, although some may be toxic in large doses. I understand that some herbs may be inappropriate during pregnancy. Some possible side effects of taking herbs are nausea, gas, stomach ache, vomiting, headache, diarrhea, rashes, hives, and tingling of the tongue.
- I understand that The Healing Chamber bkdoes not require me to participate in these activities. I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, including death, which may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such activities, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise, to the fullest extent allowed by law. I further hereby agree to INDEMNIFY AND HOLD HARMLESS the RELEASEES from any loss, liability, damage, or costs, including court costs and attorney’s fees that Release(es) may incur due to my participation in said activities, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise, to the fullest extent allowed by law.
- It is my express intent that this Waiver and Hold Harmless Agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assignees and personal representative(s), if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT TO SUE the above-named Release(es.)
I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of North Carolina and that any mediation, suit, or other proceeding must be filed or entered into only in North Carolina and the Federal or State courts of North Carolina. Any portion of this document deemed unlawful or unenforceable is severable and shall be stricken without any effect on the enforceability of the remaining provisions. In signing this document, I ACKNOWLEDGE AND REPRESENT THAT I HAVE READ AND UNDERSTAND THE FOREGOING WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT and that I am signing it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least Eighteen (18) years of age and fully competent; and I execute this Agreement
for full, adequate and complete consideration fully intending to be bound by same.