Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement
with Parental Consent Agreement (if applicable)
In consideration of being permitted to participate in any way in the Meadow Healing LLC (herein also referred to as “the Activity”) with Mika Lenee Matsuura or any representative of Meadow Healing LLC (herein referred to as “the Releasees”) at any time I, for myself, my personal representatives, heirs, and next of kin:
1. Acknowledge, agree, and represent that I understand the nature of the Activity and that I am qualified, and in proper physical condition to participate in such Activity. I further agree and warrant that if, at any time, I believe the Activity to be unsafe, I will immediately discontinue further participation in the Activity.
2. I fully understand that the Activity is experiential in nature and that exposure training is sometimes recommended as part of the Activity. I assert that I am able, with a sound mind, to identify appropriate exposures for myself at any given time. I fully accept and assume all risks and responsibility for any losses, costs, and damages I might incur as a result of my participation, or that of a minor to which I am the designated legal guardian (herein referred to as "the Minor"), in the Activity.
3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the sanctioning organization(s), their administrators, agents and employees, other participants, sponsors, owners and lessees of the premises on which the Activity is conducted, (each of the forgoing shall be considered one of the RELEASEES herein).
4. I understand that all materials, including but not limited to, workbooks, files, audios, and videos, (herein referred to as “the Materials”) shared with me by the Releasees are for my sole viewing and listening purposes and that I am legally forbidden to share or copy the Materials in part or in entirety without the expressed written permission of Mika Lenee Matsuura.
5. I understand that the Releasees are not medical doctors and any information expressed verbally, written, or otherwise by the Releasees is not intended to serve as medical advice. Information provided by the Releases is for informational purposes only and represents the opinions formed by the Releasees based on personal experience, the experiences of other clients, and research of bountiful sources of information about how illness and healing happen. No responsibility is assumed for any errors or omissions. Always seek the advice of a licensed health care provider before making any treatment decisions.
6. Due to some people who have booked appointments and not shown up, I require payment in full at the time of booking.
If I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which may be incurred as the result of such claim.
I acknowledge that I am age 18 years or older, have read this agreement and fully understand its terms, understand that I have given up substantial rights by signing it, have signed it freely, and I intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law. I agree that if any portion of this Agreement is held to be invalid, the balance, notwithstanding, shall continue in full effect.
1. Acknowledge, agree, and represent that I understand the nature of the Activity and that I am qualified, and in proper physical condition to participate in such Activity. I further agree and warrant that if, at any time, I believe the Activity to be unsafe, I will immediately discontinue further participation in the Activity.
2. I fully understand that the Activity is experiential in nature and that exposure training is sometimes recommended as part of the Activity. I assert that I am able, with a sound mind, to identify appropriate exposures for myself at any given time. I fully accept and assume all risks and responsibility for any losses, costs, and damages I might incur as a result of my participation, or that of a minor to which I am the designated legal guardian (herein referred to as "the Minor"), in the Activity.
3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the sanctioning organization(s), their administrators, agents and employees, other participants, sponsors, owners and lessees of the premises on which the Activity is conducted, (each of the forgoing shall be considered one of the RELEASEES herein).
4. I understand that all materials, including but not limited to, workbooks, files, audios, and videos, (herein referred to as “the Materials”) shared with me by the Releasees are for my sole viewing and listening purposes and that I am legally forbidden to share or copy the Materials in part or in entirety without the expressed written permission of Mika Lenee Matsuura.
5. I understand that the Releasees are not medical doctors and any information expressed verbally, written, or otherwise by the Releasees is not intended to serve as medical advice. Information provided by the Releases is for informational purposes only and represents the opinions formed by the Releasees based on personal experience, the experiences of other clients, and research of bountiful sources of information about how illness and healing happen. No responsibility is assumed for any errors or omissions. Always seek the advice of a licensed health care provider before making any treatment decisions.
6. Due to some people who have booked appointments and not shown up, I require payment in full at the time of booking.
If I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which may be incurred as the result of such claim.
I acknowledge that I am age 18 years or older, have read this agreement and fully understand its terms, understand that I have given up substantial rights by signing it, have signed it freely, and I intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law. I agree that if any portion of this Agreement is held to be invalid, the balance, notwithstanding, shall continue in full effect.
Minor Release
(must be completed by Parent/Guardian for any participant under the age of 18)
(must be completed by Parent/Guardian for any participant under the age of 18)
And I, The Minor’s parent and/or legal guardian, understand the nature of the Activity and the Minor’s experience and capabilities and believe the Minor to be qualified, in good proper physical condition to participate in such Activity. I hereby release and discharge, agree not to sue, and agree to indemnify and save and hold harmless each of the Releasee from all liability, claims, demands, losses, or damages on the Minor’s account caused, or alleged to be caused, in whole or in part by the negligence of the Releasees or otherwise.
Cancellation and Rescheduiling Policy
I require a minimum of 48 hours to cancel or reschedule an appointment. Due to understandable challenges many of my clients face in predicting how they will feel from one day to the next, I have chosen not to require payment in full for appointments rescheduled fewer than 48 hours in advance. However, due to the number of reschedules in my calendar each week, some clients taking advantage of my flexibility, and rates that I am trying to keep accessible, there will be a $25 fee for reschedules or cancellations with less than 48 hours notice. No shows will be charged at 100%.
For any session paid in advance, cancellations made 72 hours in advance will be issued a full refund minus transaction fees. For cancellations made less than 72 hours in advance, you will be refunded, less a $25 cancellation fee.
For any session paid in advance, cancellations made 72 hours in advance will be issued a full refund minus transaction fees. For cancellations made less than 72 hours in advance, you will be refunded, less a $25 cancellation fee.