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Consent and Health Declaration
Please fill out the following health declaration form in order to participate in our activity. Submissions are valid up to 24 hours prior to the activity.
______1. I am voluntarily participating in classes or services during which I will receive information and instruction about meditation. I further recognize and understand that the instructions and advice presented to me during the coaching are in no way intended as substitutes for medical and/or other professional counseling. If I have any health concerns that may interfere with my participation in the coaching, I understand that I should consult my healthcare provider before beginning the meditation exercises. ______2. I recognize that the Serenity Experience may involve physical movement, such as sitting, standing and walking meditation. I represent and warrant that I have no physical or mental health condition that would prevent my safe participation in Serenity Insight’s meditation classes. ______3. In consideration of being permitted to participate in Serenity Insight’s meditation classes, I agree to assume full responsibility for any risks, injuries or damages, known and unknown, which I might incur as a result of participating in the program. If I experience pain or difficulty that is cause for concern during or after practicing the meditation exercises, I understand that I should stop immediately and consult my healthcare provider before continuing on with the meditation exercises. ______4. In further consideration of being permitted to participate in the meditation classes, I knowingly, voluntarily, and expressly waive any claim I may have against Serenity Insight, the class instructor, the owner, or the leaseholder of the building for injuries or damages that I may sustain as a result of participating in classes or sessions held at Serenity Insight. I have read the above release and waiver of liability and fully understand its contents. By checking this box, I voluntarily agree to the terms and conditions stated above.
If your appointment is in person, are you experiencing any flu symptoms?
I confirm that the information given in this form is true
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