RAGE Workshop Waiver

Full Name of Participant

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Date of Birth

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Email Address

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Phone Number

Emergency Contact Information

Name
Name
Phone Number
Phone Number

Health Condition Confirmation [Checkboxes]

I have no underlying illness, physical injury or health limits for this event

I have minor health issues, and participate at my own personal risk

I have serious health conditions and cannot join high-risk event links

I acknowledge that:[Checkboxes]

I am voluntarily choosing to participate.

I understand this workshop may involve intense emotional experiences including anger, grief, sadness, fear, frustration, or other strong emotions.

I understand I may experience an increased heart rate, heavy breathing, sweating, muscle fatigue, dizziness, soreness, or emotional discomfort.

I understand there is a risk of accidental physical injury including strains, sprains, bruising, slips, falls, or aggravation of an existing condition.

I understand no outcome can be guaranteed.

I agree to participate only within my own physical and emotional limits.

I understand I may stop, pause, or withdraw from any activity at any time.

I agree to immediately tell the facilitator if I feel unsafe physically or emotionally.

Question[Checkboxes]

I am physically able to participate in moderate to vigorous movement.

I do not have an injury or medical condition that would make participation unsafe.

I am not currently under the influence of alcohol or recreational drugs.

I am not currently experiencing a mental health crisis.

I am not experiencing active suicidal thoughts or thoughts of harming others.

I am not currently experiencing psychosis, hallucinations, mania, or a significant loss of contact with reality.

If I have a diagnosed mental health condition, it is stable and appropriately managed, and I believe I can safely participate.

I understand this workshop is not psychotherapy, counselling, psychiatric treatment, or crisis intervention.

Medical Conditions.

Please disclose if you have any of the following:

[Checkboxes]

If other, please specify:

Responsibility.[Checkboxes]

I accept full responsibility for monitoring my own physical and emotional wellbeing throughout the workshop.

I understand the facilitator may ask me to modify an activity, take a break, or leave the workshop if my participation is considered unsafe for myself or others.

Release of Liability.

To the fullest extent permitted by law, I acknowledge that participation is voluntary and that I assume responsibility for the inherent physical and emotional risks associated with this workshop.Except where liability cannot legally be excluded, I release the facilitator from claims arising from injury, loss, or damage resulting from my voluntary participation.

Voluntary Waiver Declaration [Checkboxes]

I have read, understood and agree to all waiver terms voluntarily

I disagree with the liability waiver terms and will not participate

Signature

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Date Signed

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