Health and Liability Form

Please complete this form to help us ensure your safety and well-being during activities.

Emergency Contact Information

WAIVER OF LIABILITY

In consideration of being permitted to participate in any and all activities, services, and programs provided by Kimberly A.A. Roberts, I, the undersigned participant (or parent/guardian if under 18), do hereby affirm and acknowledge the following:

1. Release of Liability

   
   

   I, on behalf of myself, my heirs, personal representatives, and assigns, do hereby release, waive, discharge, and covenant not to sue Kimberly A.A. Roberts, any facilities where services are provided, property owners, or agents from any and all liability, claims, demands, actions, or causes of action. This includes but is not limited to:

   1. Personal injury (including death) from accidents, illness, or participation in physical or ordinary activities, including yoga, workshops, sound healing, or any organized classes or consultations.

   2. Loss, damage, or theft of personal property occurring before, during, or after participation.

2. Assumption of Risk

   
   

   I understand that the activities involved carry inherent risks, and I voluntarily assume all risks, known and unknown, associated with these activities.

PHOTO & VIDEO RELEASE AGREEMENT

I authorize Kimberly A.A. Roberts, and any facilities or agents associated with her services, to:

1. Record, photograph, or film my likeness during participation in services or events.

2. Reproduce and use photographs and video footage for educational, promotional, or advertising purposes in both online and print media, without restriction on number of uses or duration.

3. Retain ownership of all master copies of media content.

I waive any right to inspect or approve the finished product or media in which my likeness appears and understand I will not receive compensation for such use.

NON-DISCLOSURE AGREEMENT (NDA)

1. Confidential Information

   
   

   “Confidential Information” refers to all materials, training content, methods, strategies, or discussions shared during any session, workshop, or class offered by Kimberly A.A. Roberts.

2. Obligations

   
   

   As a participant, I agree:

   1. To maintain confidentiality of all proprietary or sensitive information.

   2. Not to reproduce, distribute, or share any content without prior written consent.

   3. Not to use information received for any purpose outside of my personal participation.

3. Exclusions

   
   

   This agreement does not apply to information that becomes public knowledge without breach, or is required to be disclosed by law.

ALLERGY & SENSORY SENSITIVITY WAIVER

I understand that essential oils, incense, candles, or snacks may be present during services such as workshops or classes. I agree to:

• Inform the facilitator of any allergies or sensitivities beforehand.

• Assume full responsibility for any allergic reactions or sensitivities.

• Release Kimberly A.A. Roberts and associated facilitators from liability relating to such exposures.

SOUND HEALING WAIVER

Sound healing tools such as singing bowls or tuning forks may be used during sessions. I acknowledge the potential for emotional, physical, or energetic responses and agree to:

• Communicate any sensitivities beforehand.

• Participate voluntarily and assume full responsibility for my experience.

• Release all facilitators from liability related to the use of sound instruments.

PAYMENT TERMS & THIRD-PARTY LIABILITY NOTICE

• All sales are final. No refunds will be issued once payment is received.

• Kimberly A.A. Roberts is not liable for the handling or use of personal information processed through third-party booking platforms, payment systems, or waiver collection tools. Use of such platforms is at the participant’s own discretion.