Lightening The Loss Online Grief Support Workshop - Intake Form, Release + Waiver

 

Before we dive in - let's get to know each other better. Please thoroughly review and complete the below. All information is kept confidential and is purely so I can best help you heal your heart.

All participants are required to complete this form in order to commence the course. Got a question or concern? Shoot me a note!

I am of sound mental health + capacity to undertake this e-course and, if partaking in the Solo Survivor track, have appropriate support systems in place. *
Required in order to participate.
Name *
Name
Address *
Address
I am a voluntary participant in loss&found’s grief support e-course Lightening The Loss (the “e-Course”) and I am of sound mental and physical health and capacity to partake in the e-Course and will alert loss&found if and when this changes. The e-Course is not meant to replace counseling or be a substitute for it, nor is it appropriate for people in crisis of any kind. Outcomes are not guaranteed. I understand that the activities and information presented are done so to increase my knowledge of and access to support for moving through loss and grief. I am free to decline my participation at any time. I take full responsibility for the application of any of the information, exercises or resources presented. I understand that there are exercises included in the e-course that require a certain level of physical ability and I will only engage in same insofar as I am able. I may not copy, sell, loan, use, or in any way reproduce the content or materials contained in the e-course unless expressly authorized in writing by loss&found. I release Rachel Ricketts, loss&found, and any of her/its agents, heirs, next of kin, administrators or assigns (collectively the “Released Parties”) from claims, demands, damages, actions or causes of actions arising out of or in consequence of any loss, injury or damage to any person or property arising directly or indirectly from my participation in the e-Course. Notwithstanding if the loss, injury or damage may have arisen by reason of negligence, or any claims made upon any guests or presenters. I have read and agree to the Terms of Sale and Privacy Policy set out on loss&found’s website and available here (https://www.lossandfoundxo.com/terms-of-serviceprivacy-policy). I permit loss&found's use of my name, image and likeness for further development and/or iterations of the e-course. If any provision of this Agreement shall be unlawful, void or for any reason unenforceable, then that provision shall be deemed severable from this agreement and shall not affect the validity and enforceability of any remaining provisions. This Agreement shall be governed by and construed in accordance with the laws of the Province of British Columbia and the federal laws of Canada applicable therein. My entrance to the e-Course is contingent upon my completion and return of this Intake Form + Waiver. loss&found may deny or discontinue my participation for a violation of the terms of this Waiver and/or if, in loss&found's sole opinion, I pose a threat to myself or others. BY INITIALING BELOW, I am stating that (a) I have read and agree with the above information in this Release Form for the e-Course and have had an opportunity to seek independent legal advice, (b) I fully understand all of its terms and conditions and I recognize and accept the risks in participating in the e-Course, (c) this Agreement is legally binding of full force and effect and my digital initials shall be deemed an original signature.
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