Practice Waiver and Release Form
PARTIES: “Member” is the person whose name is subscribed to this waiver, and also includes Member’s heirs, descendants, beneficiaries, communities, personal representatives, executors, statutory beneficiaries, agents, attorneys, estates, subrogees, assigns, spouses (if any), and family members, who may possess any direct or derivative claims.
“PA” means Primordial Alchemist, Inc., an Arizona limited liability company, its officers, employees, instructors, and agents, and any other persons or legal entities of any kind or nature related to or affiliated with Primordial Alchemist, Inc. and/or involved in Primordial Alchemist workshops or activities.
TERMS: “Practices” means workshops, teachings, and meditative and physical postures and exercises led by, or associated in any way with PA, including but not limited to breathing and meditative methods, awakening of dormant brain potentials and energy centers, spontaneous movement of the whole body, jumping, standing with arms in various potions for long periods, rolling, crawling, going underwater, hiking, running, spinning, walking, and moving energy inside the body. “Site” means the public or private property upon which the PA Practices take place. “Site Owner” means the owner, lessee, or occupant of the Site.
FITNESS TO PARTICIPATE: Member certifies that he/she does not have any physical limitations, medical ailments, or physical or mental disabilities that would limit or prevent Member from participating in Practices. Member certifies that he/she is over 18 years of age and does not have bipolar disorder, blood cancer, kidney dialysis, or active drug or alcohol addiction or use. Participation in Practices with any of these conditions or a family history of same may be dangerous.
ASSUMPTION OF RISK: Member understands that there is inherent risk of injury in participating in PA Practices and that while performing Practices, Member could sustain minor or serious bodily injury, or catastrophic injury, paralysis, or death.
WAIVER & RELEASE: Member desires to participate in PA Practices and receive instruction related thereto. In consideration of such participation, Member hereby releases, indemnifies and holds harmless PA from any and all claims, demands, personal injuries, costs or expenses arising out of Member’s participation in PA Practices. Member agrees that PA or the Site Owner shall only be liable upon a showing that PA or the Site Owner was guilty of willful, malicious, or grossly negligent conduct that directly caused injury to Member. Member also waives all claims arising from Member’s participation as a PA apprentice.
ADJUSTMENTS: Member agrees and understands that the PA team may adjust Member’s body with their hands at certain times throughout the Practice and Member allows them to do so.
LAW: The laws of the State of Arizona shall govern this Waiver. Any judicial proceeding brought under this Waiver shall be brought in the Superior Court of the State of Arizona, County of Yavapai. Each provision and term of this Waiver is severable. Member agrees that this paragraph is a negotiated item and is integral to this Waiver and participation in PA Practices. All actions against PA or the Site Owner shall be brought within ONE YEAR after the cause of action accrues and not afterward. Member acknowledges and agrees that Member has carefully read this Waiver, that Member fully understands the same, that Member is freely and voluntarily executing the Waiver, and that Member is giving up substantial rights by executing the Waiver. This agreement contains the entire agreement between the Parties with respect to waiver and release of PA for Member’s participation in Practices, and shall not be modified except in writing signed by both parties.
All right to the methods taught to Member by PA are reserved. Member agrees to not teach PA methods unless Member has written advance permission by PA. Member understands that no video, cell phone recording, or photography is allowed. No part of the methods may be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from PA.
Video Waiver and Release
I hereby grant permission to Primordial Alchemist, Inc., the rights of my image, in video or still, and of the likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.
Photographic, audio or video recordings may be used for ANY USE which may include but is not limited to: * Presentations; • Courses; • Online/Internet Videos; •Media; • News (Press); *Advertising purposes
By signing this release, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public educational setting. I understand that Primordial Alchemist, Inc. will own and retain all rights and that this does not form a professional relationship between Primordial Alchemist, Inc. with any other party or entity. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.
I will be consulted about the use of the photographs or video recording for any purpose other than those listed within the guidelines of this document.
This release applies to photographic, audio or video recordings collected as part of Primordial Alchemist, Inc. sessions, trainings, workshops, events, that you take part in, attend, or join.
By signing this release, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for purposes outlined in this document.
Primordial Alchemist, Inc.www.primordialalchemist.com * [email protected]