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Informed Consent Form

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LIABILITY WAIVER AND RELEASE AGREEMENT
ACKNOWLEDGMENT, RELEASE, HOLD HARMLESS, AND ASSUMPTION OF POTENTIAL RISK AGREEMENT

Full (Legal) Name

Location of Event

Start Date of Event

End Date of Event

Covered Activity

This Liability Waiver and Release Agreement must be completed for each event (may cover multiple dates for the same event).
I, the undersigned wish to participate in the event or activity as referenced above (from now on referred to as “Activity”). I understand and acknowledge that this Activity is voluntary. While the event may not be dangerous, I know that sensitive information about myself, my family, or my business affairs may pose the potential risk of severe emotional injury or illness to any individual who participates in such activity. I know that no medical treatment coverage or liability coverage is provided in connection with this activity.
I understand and acknowledge that to participate in this Activity I agree to assume all liability and responsibility for all potential risks, or injuries associated with participating in such activity.
I understand and acknowledge that this Activity is voluntary. While the event may not be dangerous, I know that sensitive information about myself, my family, or my business affairs may pose the potential risk of severe emotional injury or illness to any individual who participates in such activity. I know that no medical treatment coverage or liability coverage is provided in connection with this activity.
I understand and acknowledge that to participate in this Activity I agree to assume all liability and responsibility for all potential risks, or injuries associated with participating in such activity.
I represent and warrant that I am mentally and physically fit, capable, able, and willing to participate in this Activity without any limitations.
I understand, acknowledge, and agree that the contractor performing the activity shall not be liable for any injury/illness suffered by the Participant associated with preparing for or participating in this Activity.
I release, discharge, indemnify, and agree to hold harmless the contractor, consultant, and any governing body free from all liability arising from or in connection with the participant's participation in the activity. For this Release, liability means all claims, demands, losses, causes of action, suits, or judgments of any kind that the participant or any heirs, executors, administrators, and assigns may have against the contractor, consultant, and any governing body because of participant’s personal, emotional injury, accident, or illness, or because of any loss of or damage to property that occurs to the participant or his or her property during their participation in the Activity that may result from any cause including but not limited to the contractor, consultant, and any governing body's passive negligence of acts other than fraud, willful misconduct, or a willful violation of the law.
Participants who do not wish to accept the risks described in this Agreement should not sign this Agreement, and will not be allowed to participate in the Activity.
I acknowledge that I have carefully read this voluntary participation form and that I understand the potential dangers of engaging in this Activity, I am fully aware of the legal consequences of this agreement and agree to its terms and understand I am waiving certain rights and assuming the risk of damage from my participation in the Activity.
I understand that psychic and tarot readings are only for those aged eighteen and older. I understand that both psychic and tarot readings are for entertainment purposes only under NYS Penal Law §165.35 and 18 P.A.C.S. § 7104.

Signature

Signature

Today's Date