Release of Liability Form

RELEASE / RESPONSIBILITY: The undersigned participant agrees that Michelle Quirk, MD shall not be held liable for any injury, damage, loss, delay or irregularity that may occur for any reason, including but not limited to any defect in a vehicle, property, food and food service, animal bites, acts or default of any company or person engaged in conveying a participant, acts of God, natural disasters or unforeseen events, delays or expenses arising from such occasions. I hereby acknowledge that I am participating in a retreat/ meditation training/ yoga class/workshop/mindful movement/run/walk offered by Michelle Quirk, MD, agent/instructor. I understand that the physical reaction to exercise and the practice of meditation cannot always be predicted with accuracy and that there is risk involved in such activity. I understand that Michelle Quirk, MD, agents/instructors shall not be liable for any damages arising from personal injuries sustained or incurred during class or training sessions or while on the premises.

By checking the box in registration, the participant assumes full responsibility for any injuries or damages which may occur during class or training or while on premises of the retreat. I hereby fully and forever release and discharge Michelle Quirk, MD, from any and all claims, demands, damages, rights of action, present and future therein. I assume full responsibility for any risks, injuries, damages, known or unknown, which I might incur as a result of participating in class/training/retreat. I understand and warrant, release and agree that I am in good physical and mental condition and that I have no disability, impairment or ailment preventing me from engaging in active or passive exercise that will be detrimental to heart, safety, comfort or physical condition if I engage or participate in this activity. I hereby voluntarily waive any claim I may have against Michelle Quirk, MD and their agents, Independent Contractors, and officers for any injuries or other damages that I may sustain as a result of participating in this retreat, meditation training, yoga class, run/walk, hike, or other related activity. 

MEDICAL ADVICE: By signing below I understand that Michelle Quirk, MD, will not be providing medical advice and I voluntarily waive any claim I may have against her or her agents.

MEDIA CONSENT AND RELEASE: Michelle Quirk, MD  will be photographing and/or  digitally recording portions of the retreat. Without expectation of compensation or other remuneration, now or in the future, I hereby give my consent to Michelle Quirk, MD, and affiliates and agents, to reproduce, edit, distribute, and otherwise use my image and likeness and/or any interview or written statements from me in its publications, website, social media, advertising or other media activities (including audio, video, television, and the Internet). I release Michelle Quirk, MD from liability and all claims related to such use. I agree that all images, video, and statements are the exclusive property of Michelle Quirk, MD. This consent is given in perpetuity, and I waive the right to disapprove or approve the final content created. This consent includes, but is not limited to: (a) Permission to use video or images of me and/or recording of my voice; (b) Permission to use my name; and (c) Permission to use quotes of my written or recorded statements (or excerpts of such quotes), in part or in whole. 

ADDITIONAL CONDITIONS: Refunds: No refunds will be made for any classes or other activities that the participant misses or decides not to participate in for any reason, or if the participant leaves prior to the retreat conclusion. Force Majeure/Acts of God: In the case that unforeseen circumstances beyond the reasonable control of Michelle Quirk, MD, shall not be considered in breach of its obligations and shall not incur any liability for any losses or damages of any nature whatsoever incurred by you. 

Conduct: I agree to behave respectfully toward all participants, organizers, and retreat staff for the duration of the retreat, or you may be asked to leave at your expense with no refunds. Please acknowledge your agreement to this Release of Liability by checking the appropriate box in the retreat registration form on the registration webpage. 

By checking the box in registration, I agree to all of the conditions in the above document.