WAIVER AND RELEASE FROM LIABILITY FORM OF INGRID ELKAYAM HEVRONI

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I, ____________________, my heirs, dependents, spouse, parents, family and/or legal representatives hereby waive and release, indemnify, hold harmless, covenant not to sue and forever discharge Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns, of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, liability of injury, loss, or damage associated with my participation in, and any subsequent following of, coaching, advice and/or direction received from coaching sessions of every kind and nature, including any claims of owner or employee negligence, whether known or unknown, in law or equity, that I, my heirs, dependents, spouse, parents, family and/or legal representatives ever had or may have, arising from or in any way related to my participation in any of the events, private sessions or activities, and for the duration of my visits conducted by, on the premises of, or for the benefit of, or with telephone, internet or video conferencing of any kind of or with Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns. I, my heirs, dependents, spouse, parents, family and/or legal representatives accept and assume such risks and responsibilities for the losses and/or damages following such psychological or physical injury, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of the client or Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns. I, my heirs, dependents, spouse, parents, family and/or legal representatives acknowledge that in signing this waiver I/we agree that my/our following any advice and/or information received from the website and any life coaching sessions with Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns is done strictly out of my own free will and that results and/or outcomes are not guaranteed. I, my heirs, dependents, spouse, parents, family and/or legal representatives acknowledge that in attending coaching sessions with Ingrid Elkayam Hevroni and her company, agents, staff, employees, officers, directors, affiliates, successors and assigns, I/we am/are receiving personal motivational coaching services only and that such coaching and/or advice is the sole opinion of Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns based on her particular experiences and knowledge, and is not, in any way, professional, business, medical, or financial information, services or advice. I, my heirs, dependents, spouse, parents, family and/or legal representatives understand that Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns, offer/s to her clients coaching, life goals, consultation and/or social intercourse in a specific time block, in exchange for payment. Nothing further is stated, suggested or implied. I, my heirs, dependents, spouse, parents, family and/or legal representatives further acknowledge that Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns suggests that I/we consult my/our medical doctor, psychologist, financial planner, or other such experts for accuracy of information and to confirm that such advice is in my/our best interest. The opinions, advice, and counsel provided by Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns are not to be used as a substitute for medical attention, diagnosis, or treatment, or for other professional mental health or medical services or for any other financial, spiritual or professional services of any kind. I, my heirs, dependents, spouse, parents, family and/or legal representatives understand that Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns is/are not a licensed psychological or counseling service and does not offer such services. Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns will not be held liable for the use that I, my heirs, dependents, spouse, parents, family and/or legal representatives might make of the information or advice given. Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns stresses and emphasizes self-reliance and individual self-determination. I, my heirs, dependents, spouse, parents, family and/or legal representatives am/are never justified to take or withhold any action as a result of conversations with Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns, or purchase of any materials from Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns. I, my heirs, dependents, spouse, parents, family and/or legal representatives understand that I may not achieve goals during or after my coaching. I, my heirs, dependents, spouse, parents, family and/or legal representatives understand that accepting the services and/or products of Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns does not guarantee nor imply any specific outcome or success. I, my heirs, dependents, spouse, parents, family and/or legal representatives take full responsibility for any and all actions resulting from coaching with Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns, and will not hold Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns liable for my/our failure to achieve my/our personal, professional, emotional, mental, financial, spiritual, or any other form of life goals for myself or any of my children, dependents or minors and all family members who accompany me or who are under my care. I, my heirs, dependents, spouse, parents, family and/or legal representatives understand and agree that all coaching sales are final, and no refunds will be given for services that I/we have received or failed to attend. Sessions canceled less than 48 hours in advance will require payment in full. All sessions are one hour. No refunds once paid. I, my heirs, dependents, spouse, parents, family and/or legal representatives understand that client payments made to Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns are solely and exclusively for coaching, the purchase of a block of time spent in conversation, or for educational or inspirational media materials and nothing further is being represented as being sold. Clients often reveal confidential and personal information to Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns. Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns warrant that we take reasonably prudent precautions to safeguard such conversations and information. However, I, my heirs, dependents, spouse, parents, family and/or legal representatives understand that no representation is made as to whether a client confidentiality privilege might exist under law, and Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns comply with applicable law, regulations, and court orders should disclosure be mandated. I, my heirs, dependents, spouse, parents, family and/or legal representatives understand that there is no guarantee of privacy through telephone, internet and video conferencing. I, my heirs, dependents, spouse, parents, family and/or legal representatives understand that Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns may consult with another person in regards to the client/s. This WAIVER AND RELEASE contains the entire agreement between the parties, and supersedes any prior written or oral agreements between them concerning the subject matter of this WAIVER AND RELEASE. The provisions of this WAIVER AND RELEASE may be waived, altered, amended or repealed, in whole or in part, only by Ingrid Elkayam Hevroni. The provision of this WAIVER AND RELEASE will continue in full force and effect even after the termination of the activities conducted by, on the premises of, or for the benefit of Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns, whether by agreement, by operation of law, or otherwise. If, despite signing this release, the undersigned participant makes a claim against any of Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns, the undersigned participant will reimburse Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns for any and all money which Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns has paid to the participant, or on his/her behalf, including but not limited to any and all compensation, lawyer and court fees and will hold Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns harmless. I, my heirs, dependents, spouse, parents, family and/or legal representatives hereby agree that the venue of any legal proceedings against Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns, shall be solely and exclusively maintained in the county, state and country in which Ingrid Elkayam Hevroni resides, wherever that may be globally, and in no other locality whatsoever under any circumstance. I, my heirs, dependents, spouse, parents, family and/or legal representatives understand that Ingrid Elkayam Hevroni will solely and exclusively decide if any and all legal proceedings will go through and be finalized in arbitration, mediation or a court/judge. This WAIVER AND RELEASE shall be governed by the laws of the State of Florida. I have read, understand and fully agree to the terms of this WAIVER AND RELEASE. I understand and confirm that by signing this WAIVER AND RELEASE, I, my heirs, dependents, spouse, parents, family, and/or legal representatives have given up considerable and all future legal rights. I have signed this agreement freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to me. My signature and/or electronic signature is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability to the fullest extent of the law. I acknowledge that I have had the full opportunity to discuss with Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns the nature of the services to be provided and/or the consultation to be rendered. I am 18 years of age or older and mentally competent to enter into this waiver. I represent that I am not aware of any mental, physical or health condition of myself or anyone else whom I know of that receives services from Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns that would be adversely affected by the services being rendered by Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns. I attest to the fact that I have disclosed all relevant information regarding my or my dependent/s physical, emotional, mental or spiritual conditions that could cause harm to me by participating in sessions with Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns. This Agreement and its terms and provisions will include any minors and all family members who accompany me or who are under my care. I further agree that I shall assume responsibility for watching and caring for the minor’s and family member's safety and guarding against all hazards, whether explicitly mentioned in this WAIVER AND RELEASE or otherwise. I understand that by engaging in the services of Ingrid Elkayam Hevroni and/or her company, agents, staff, employees, officers, directors, affiliates, successors and assigns, I specifically agree to all of these terms and conditions. I attest to the fact that I understand everything and all that I am signing for.

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_______________________Full Name

 

_______________________Signature

 

_______________________Date