TERMS AND CONDITIONS

PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK

In consideration of the services of Jessica Rosin Psychology Services, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf, I hereby agree to release, indemnify, and discharge Jessica Rosin Psychology Services, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:

1. I expressly agree and promise to accept and assume all of the risks existing in participating in the Coming Alive in Life and Love Online Program. I acknowledge that participation in this program will include emotional, psychological, and interpersonal exploration both individually and in groups that entail known and unanticipated risks that could result in psychological and interpersonal injury to myself or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities and benefits of the program. My participation in this program is purely voluntary and I elect to participate in spite of the risks.

2. I acknowledge that this program may include outdoor activities that entail known and unanticipated risks that could result in physical or emotional injury or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential

qualities of the activity.

Furthermore, Jessica Rosin Psychology Services employees may be unaware of a participant's fitness or abilities, so please inform them if you have any restrictions or limitations so that accommodations can be considered and implemented.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Jessica Rosin Psychology Services from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of Jessica Rosin Psychology Services’ equipment or facilities, including any such claims which allege negligent acts or omissions of Jessica Rosin Psychology Services.

4. Should Jessica Rosin Psychology Services or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have. By checking this box for this document, I acknowledge that if anyone is psychologically or physically hurt or property is damaged during my participation in this program, I may be found by a court of law to have waived my right to maintain a lawsuit against Jessica Rosin Psychology Services on the basis of any claim from which I have released them herein.

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms by clicking this box and agree.