Class, Workshop & Event Waiver In consideration of attending a classes, workshop, or event facilitated by Kate Shipp, The Window Within LLC, I hereby declare as follows: Please initial in each box.The Client agrees that Kate Shipp is not and will not be liable or responsible for any actions or inaction, or for any direct or indirect result of any services provided by Kate Shipp.(Required)Client understands the classes or workshop are not therapy and does not substitute for therapy if needed, and does not prevent, cure, nor treat any mental disorder or medical disease.(Required)Client acknowledges that Kate Shipp does not involve the diagnosis or treatment of mental disorder as defined by the American Psychiatric Association, and that your sessions are not to be used as a substitute for counseling, psychotherapy, psychoanalysis, mental health care, substance abuse treatment, or other professional advice by legal, medical or other qualified professionals. Client acknowledges that it is the Client’s exclusive responsibility to seek such independent professional guidance as needed.(Required)If Client is currently under the care of a mental health professional, it is recommended that the Client promptly inform the mental health care provider of the nature and extent of the agreed upon work by the Client and Kate Shipp.(Required)That Kate Shipp has informed me, and I am aware, that she is not licensed under the laws of this state to practice any form of medicine. That she has stated she will neither diagnose nor prescribe for any condition or problem from which I may appear to be suffering.(Required)I understand this is a non-medical program and that any changes I decide to make to my medication or physician prescribed activities will be discussed with said physician.(Required)I understand the said individual practices Yoga Therapy, Breath Therapy, Life Coaching, Energy Medicine, and all are integrative somatic healing arts modalities, combining the ancient science of yoga with elements of contemporary body/mind psychology, and the teachings of Jesus upon request.(Required)I understand and agree that in participating in any movement class or workshop that there is a possibility of physical injury. The Window Within, LLC, Kate Shipp recommends that I check with my physician before engaging in this class, and I have done so, or made a decision that I do not need to do so.(Required)I understand that this offering will be recorded, and may be used for future educational and marketing purposes. I consent to the recording of my person, and my participation is completely voluntary, and will seek no compensation for my contribution.(Required)I, my heirs, or legal representatives, do hereby waive and release Kate Shipp from any and all liability and responsibility from injury, accident, illness, legal and medical fees sustained now or in the future resulting from my sessions. I acknowledge that I have read this waiver of liability form. I acknowledge that I am signing this agreement voluntarily and intend by my signature to be a complete and unconditional release of liability to the greatest extent allowable by law.(Required)That the said individual has informed me, and I understand that no guarantee or promises of cures have or will be made to me and that any benefits which I experience come from within my own awareness and self-knowledge.(Required)Waiver of Liability/Hold Harmless: By signing this liability waiver, I agree and acknowledge that I may be giving up important legal rights and remedies available to myself. For value received, I agree on behalf of myself that I assume all risks and waive any liability of any nature whatsoever against and agree to hold harmless The Window Within, LLC, Kate Shipp and associated staff with respect to any and all actions, claims or demands that may be made or brought on our behalf against The Window Within, LLC, Kate Shipp and associated staff arising out of or in connection with travel to or attendance at any classes, events, or any other activity I may engage in while in transport there. Further, for value received, for any injury to third parties that may arise because of my actions or omissions, I agree to hold harmless and defend The Window Within, LLC, Kate Shipp and associated staff with respect to any and all actions, claims, expenses or demands arising there that may be made or brought against The Window Within, LLC, Kate Shipp and associated staff , including but not limited to reasonable attorneys’ fees and expenses arising in connection therewith.(Required)That my true and legal name is signed below and not otherwise.(Required)That I am 18 years of age or older or have the signature below of my Legal Guardian.(Required)I understand that all information shared in sessions is private and held in complete confidentiality unless there is evidence of crisis or self-harm. In which Kate Shipp must refer out for further care.(Required)I have read and understood the content of this form. I hereby certify that I have read the foregoing and fully understand the meaning and effect thereof, and intending to be legally bound.Signature(Required)Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) CAPTCHA
