Consent form - Fairfield Retreat- online
Trillium Awakening in Fairfield
Informed Consent, Conditions of Participation, Assumption of Risk and Release
You will be emailed a version of this consent form that you will be able to fill out and submit online.
I accept the following conditions of participation in the Fairfield Retreat, October 11-14, 2024, held online via Zoom and produced by the Trillium Awakening (TA) Teachers and Mentors in Fairfield, Iowa along with any other Teachers and Mentors the Fairfield TA Teachers have invited to co-teach at this retreat. These Teachers and Mentors are referred to in this document as "The Teachers".
COPYRIGHT: I accept that the Fairfield Retreat 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 the Fairfield Retreat, and that no materials may be copied, reproduced or distributed without the written consent of The Teachers.
RECORDINGS BY THE TEACHERS: All or portions of the course may be recorded on various media by The Teachers. If so, I understand that this will be announced at the beginning of the course 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, The Teachers have my consent to use recordings of my participation in any manner it chooses.
CONFIDENTIALITY: I understand that participants may disclose very personal and confidential information during the 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 in the event with anyone I choose, so long as the confidentiality of the event and participants is maintained and copyright laws are not infringed. I understand that The Teachers cannot guarantee that other participants will respect the confidentiality of my communications or actions, and I freely release and forever discharge The Teachers 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 The Teachers harmless from the consequences of such disclosure.
PERSONAL ISSUES: 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 that 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.
HEALTH MATTERS: 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 wellbeing. If I experience significant mental or physical distress, I agree to immediately inform The Teachers. 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 event with him/her and have obtained his/her consent to attend.
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 any of the event's teleconference meetings at any time. I will notify The Teachers if I choose to leave. I agree to follow reasonable directions of The Teachers, not disrupt the event or be verbally abusive to the teachers or other participants. I understand that The Teachers may request that I leave the event at any time, and if so requested I agree to leave immediately. I will not attend the event under the influence of non-prescription mood-altering substances or alcohol. I will not bring recording devices of any kind into the event online meetings. 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 emotional stress. I agree that the teachers 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 the teachers of this event from liability for any personal injury, illness, death, property damage, or other liability that may occur during, as a result of, or in connection with this 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 The Teachers, 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.
BINDING ARBITRATION: 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.
Signature _____________________________________ Date _______________
Printed name ____________________________________________