informed consent agreement
Informed Consent for 2018 Transfiguration Retreat
I accept the following conditions of participation in this course, produced by the Olympia Trillium Community (OTC) and sponsored by Institute of Awakened Mutuality (IAM), an Oregon not-for-profit corporation. All information provided by me in the registration form is true and correct.
I understand that participants may disclose very personal and confidential information during this event, and I agree to respect the confidentiality of all participants – their names, remarks, and actions – as well as the content of the event itself. This agreement does not preclude me from sharing my experiences at this event with anyone I choose, so long as the confidentiality of the event and its other participants is maintained and copyright laws are not infringed. I understand that OTC and IAM cannot guarantee that other participants will respect the confidentiality of my communications or actions, and I freely release and forever discharge OTC and IAM and each of its present and former officers, directors, employees, agents, representatives, volunteers, successors, assignees, and all persons acting by, through, under, or on behalf of OTC and IAM (collectively, “Representatives") from any liability arising out of, or relating to, the disclosure of such communications or actions. My disclosures, if any, are entirely voluntary on my part and I agree to hold OTC and IAM and their Representatives harmless from the consequences of such disclosure. I accept that this event, and all processes and materials, are copyrighted and intended solely for the personal, non-commercial use of the participants, that participants may make no recordings of any kind during this event, and that no materials I receive may be copied, reproduced or distributed without the written consent of OTC and IAM.
Personal Issues Addressed:
I have been informed that this event is intended for emotionally mature and stable individuals and is a deep inquiry into spiritual, religious, and ontological domains and into what it means to be fully human. As such, fundamental issues of God and Being, identity, religious beliefs, values, and cherished ideals may be addressed and challenged, and repressed emotions, suppressed memories, bodily reactions, and other discomforts may be experienced. I understand and accept and assume the risk that this event may be mentally, spiritually, physically, or emotionally stressful, and that persons unwilling to encounter such experiences or who feel they may be unable to handle them, should not participate in this event.
I understand that this event is not therapeutic in design, intent, or methodology and is not a substitute for the services of a psychologist or other mental health professional. Also, I understand that I am solely responsible for my mental and physical well-being and that there are no medical personnel in attendance. If I sustain an injury, no matter how minor, or experience significant mental or physical distress, I agree to immediately inform the course leader. I certify that I am in good physical and mental health and that if I am under the care of a physician or mental health professional, I have discussed my participation in the course with them and have obtained their consent to attend.
Recording by OTC and/or IAM:
Portions of the course may be recorded on various media by OTC and/or IAM. If so, I understand that this will be announced prior to any recording and that I will be given instructions as to how I may decline to participate in such recording(s). Unless I express such a preference in writing at or before the time of the recording, OTC and/or IAM has my consent to use recordings of my participation in any manner it chooses.
Conditions of Participation:
My participation in this event is entirely voluntary. I understand that I may decline to participate in any event activity, may leave the room at any time, and may leave this event if I so choose. I agree to follow reasonable directions of the event leaders, not disrupt the event or be physically or verbally abusive to other participants, attend all sessions of the event unless I notify event leaders, and be on time. I understand that OTC and/or IAM may request that I leave the event at any time, and if so requested I agree to leave immediately. I will not attend under the influence of non-prescription mood-altering drugs or alcohol. I will not bring recording devices of any kind into the room. I understand that no refunds will be given once the event begins, even if I choose not to complete the event or am asked to leave.
Informed Consent and Release:
I am aware and understand that this event involves a potential risk of physical and/or emotional stress. I agree that OTC and IAM are responsible only for the orderly presentation of this event, and that I am solely responsible for my participation and for my own well-being. It is my intention to exempt and relieve OTC and IAM and their Representatives from liability for any personal injury, illness, death, property damage, or other liability that may occur during, as a results of, or in connection with this event, including without limitation, travel to, from, or during the course of the event. I willingly and knowingly assume for myself and my heirs, family members, executors, administrators, and assigns, all risk of physical injury and mental or emotional upset which may occur during or after my participation in this event, and I hereby agree to hold OTC and IAM and their Representatives harmless from any and all liability arising out of my participation in this event. I certify that I am at least 18 years of age and am not under the supervision of a guardian or custodian. This release shall be legally binding upon me personally, my heirs, all members of my family, executors, and administrators.
I agree that any dispute concerning, relating, or referring to this agreement or event shall be resolved exclusively by binding arbitration according to the then-existing rules of the American Arbitration Association. Such proceedings shall be governed by substantive Oregon law.