"*" indicates required fields CONSENT AND LIABILITY RELEASE AGREEMENT In consideration of participating In The Shipp Method™ Intro Into Spiritually Embodied Living, by Kate Shipp, The Window Within LLC, I hereby declare as follows: Please initial in each box.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.*I understand this is a non-licensure program, and this training does not allow me to call myself a licensed or certified trauma therapist.*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.*I understand that this training 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.*I, my heirs, or legal representatives, do hereby waive and release Kate Shipp and The Window Within, LLC from any and all liability and responsibility from injury, accident, illness, legal and medical fees sustained now or in the future resulting from this training.*I, my heirs, or legal representatives, do hereby waive and release Kate Shipp and The Window Within, LLC from any and all liability and responsibility from injury, accident, illness, legal and medical fees sustained now or in the future resulting from this training.*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.*I understand this training includes yoga philosophy and postures, breathwork, meditation, and some teachings on the neuroscience of trauma. I understand that none of these modalities is a substitute for medical treatment for you or students you will teach at a later date.*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/from and at attendance at this training. 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.*That my true and legal name is signed below and not otherwise.*This program does not replace medical or professional care. Please be sure to seek professional support as needed. This program is for educational purposes only. It is not for credentialing. You will receive a certificate of completion once the case study portfolio is submitted, reviewed, and approved. You agree to seek out therapeutic support as needed during and after the training. 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, have signed it.Signature*Date: 04/24/2024Name* First Last Address* 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*Email*
