Consent Waiver (Minor) FOR AND IN CONSIDERATION of my (the undersigned) participation in massage sessions with Amanda Karg, and the use of any premises, facilities, and/or equipment provided or recommended to me by Amanda Karg in connection therewith (collectively “Sessions”), to the fullest extent permitted by applicable laws, I agree as follows: I acknowledge and I am aware of the hazards, dangers and risks (inherent or otherwise) in connection with the Sessions, including, without limitation, illness, economic loss, accident, minor personal injury or serious personal injury (known or unknown), which may include permanent disability or paralysis, or death to myself. I further acknowledge that there are natural factors and occurrences which may impact or affect the safety of the Sessions. I warrant that I am in good health and have no physical conditions that would prevent me from acting in connection with the Sessions. I assume full responsibility for, and all risk of, any accident, bodily injury (including illness), death, property loss, or economic damage that may result for any reason, including by acts of negligence, in connection with the Sessions, whether caused by Amanda Karg, and/or her related companies or individuals, affiliates, successors, and/or subsidiary companies (and/or her respective owners, officers, directors, employees, agents, landlords and/or sublandlords) (collectively, the “Releasees”), me, any third persons, or otherwise. If I become injured or ill during the Sessions, I authorize the Releasees to administer, or cause and consent to the administration of, whatever first aid, medical care, dental care or other treatment and medications as may be necessary under the circumstances, including treatment by a physician, emergency medical technician, dentist or hospital (“Treatment”), although I acknowledge that the Releasees have no obligation to do so and that the Releasees do not endorse the services of any physician or hospital that may provide such Treatment. I understand that the Releasees will have no obligation to pay any such costs of any Treatment and agree to reimburse the Releasees for any such costs incurred. I have consulted with my medical doctor and/or health care provider about engaging in the Sessions, and I warrant that my medical doctor or health care provider has authorized and cleared me to engage in these activities. I will update Amanda Karg with any changes in my health, and Amanda Karg shall not be liable for any damages should I fail to do so. If I am experiencing any physical issues, illness, or symptoms thereof, and I intend to proceed with one of the Sessions, I will advise Amanda Karg of any physical issue, illness, or symptoms thereof before the Session, and Amanda Karg may, in her sole discretion, determine whether to cancel the Session(s). I understand and agree that any information provided by the massage therapist shall be for educational purposes only and is not diagnostically prescriptive. I agree that the Sessions are not a substitute for medical examination or diagnosis, and I acknowledge that I should consult with a physician for any physical ailment that I may have. I RELEASE, AGREE NOT TO SUE, AND AGREE TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES of and from any and all claims, causes of action, suits, demands, damages, losses, liabilities, costs, expenses and any actions of any kind whatsoever (collectively "Claims"), known or unknown, existing now or in the future, that I, my heirs, executors, administrators, next of kin, assigns or any third party may now or hereafter have against the Releasees, arising in any way as a result of or in connection with the Sessions and any treatments, including, without limitation, any property loss, bodily injuries, disability, death or other damage suffered by me, my heirs, executors, administrators, next of kin and assigns or any other party and regardless of any fault or passive or active negligence on the part of the Releasees, myself or any third party. I expressly waive and relinquish all rights and benefits afforded by California Civil Code Section 1542 and do so understanding and acknowledging the significance of this specific waiver of Section 1542. Section 1542 states as follows: “A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM OR HER MUST HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR.” This Agreement constitutes my entire understanding regarding the subject matter of this Agreement and supersedes any prior statements, agreements or representations (written or oral) regarding that subject matter. No oral representations, statements or inducements apart from this Agreement as written have been made to me. I agree that this Agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, such invalidity will not affect any other provision that can be given full effect without the invalid provision. The laws of the State of California shall apply to and govern this Agreement, without regard to conflicts of laws principles, and I consent to the jurisdiction and venue of the federal, state and local courts located in Los Angeles County, California. I have carefully read this Agreement, and I know and understand what it means, including that it is a complete waiver and release of liability and promise not to sue or make a claim against Amanda Karg and/or the Releasees. My signature below is my own free and voluntary act and I intend this Agreement to be legally binding on me. Electronic Signature * First Name Last Name Date * MM DD YYYY If Participant is under 18 years of age: I am the parent or legal guardian of the minor engaging in the Sessions (“Participant”). I understand the legal consequences of signing this document, including (a) releasing Amanda Karg and the Releasees from all liability on the Participant’s behalf, (b) promising not to sue Amanda Karg and the Releasees, on my and/or the Participant’s behalf, (c) and assuming all risks of Participant’s participating in the Sessions, including travel to, from and during the Sessions. I allow Participant to participate in the Sessions. I understand that I am responsible for the obligations and acts of Participant as described in this document. I agree to be bound by the terms of this document. I have read this document, and I am signing it freely. If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive these rights. Electronic Signature * First Name Last Name Date * MM DD YYYY Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country IN EMERGENCY, PLEASE CONTACT: Name * First Name Last Name Phone * (###) ### #### Thank you!
