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Cart
0
Attend
Courses, Retreats, & More
Calendar
Course Information
Online Community
Currents
MBMS Currents
Mindfulness/Meditation
Relationship with Earth & All Beings
Outdoor Engagement
Evolution of Consciousness / Spirituality
Programs
Being Outdoors
S'mores Stories
HomePlace
About
Our Values
Community Guidelines
Racial Equity
A Space for Meditation, Connection, Reflection and Learning
Constellation
Our Elemental Beings:
Orbs
Liminaria
Mycelia
Our Kin:
conscious collaboratory
Enlivened Cooperative
Eutierria Connection
Good Grief Network
Habitat Stewardship Project Monterey Bay
Reclaiming our Original Motherline of Love
The Earthbody Institute
Whites for Racial Equity
Blog
Connect
Outdoor Event Liability Release & Photo Release Form
Name
*
First Name
Last Name
Date
*
MM
DD
YYYY
Emergency Contact
First Name
Last Name
Emergency Contact Phone
(###)
###
####
Please list any allergies (insect bites, bee stings, medications, etc.) PLUS any medical alert info:
Liability Waiver
*
Outdoor programs offered by Monterey Bay Meditation Studio support participants in experiencing a deep and nurturing connection with the natural world, as well as a deep experience in their internal world. These programs involve a modest level of physical activity, and great care is taken to support participants’ well-being. Nevertheless, participation in any physical exercise or outdoor activity involves inherent risks that cannot be eliminated, regardless of the care taken to avoid injuries. I understand that this event carries with it inherent risks that include, but are not limited to: bruises, sprains, other injuries, exposure to poison oak, and reactions to insect bites or stings. I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of my participation in the event. By signing my name below, I acknowledge that participation in the event exposes me to a possible risk of personal injury. I am fully aware of this risk and hereby release Monterey Bay Meditation Studio and Marianne B. Rowe and/or Katie Dutcher and/or Jennifer Farley, all other participants, and the owner(s) of the premises from any and all liability, negligence or other claims arising from or in any way connected with the event. My signature further acknowledges that I shall not now or at any time in the future bring any legal action regarding this event against Monterey Bay Meditation Studio, Marianne B. Rowe and/or Katie Dutcher and/or Jennifer Farley, any other participant or the owner(s) of the premises; and that this waiver is binding on me, my heirs, my spouse, my children, my legal representatives, my successors and my assigns. My signature is binding to this liability waiver from this day forth. I HAVE READ THE ABOVE AND FULLY UNDERSTAND ITS PROVISIONS. I give my permission to Marianne B. Rowe and/or Katie Dutcher and/or Jennifer Farley to seek emergency medical diagnosis or treatment for me in the event that I am unconscious or unable to make my own decisions. Marianne B. Rowe’s and/or Katie Dutcher’s and/or Jennifer Farley’s role in offering medical treatment will be limited to emergency first-aid and either transportation to the nearest medical facility, or contacting such a facility to arrange emergency transport. Completing the fields below is your electronic signature.
First Name
Last Name
Permission for Photo Release
*
I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by Monterey Bay Meditation Studio and/or HomePlace, including online presence, future marketing or advertising.
I accept
I decline
Thank you!