Star Experience LLC
Retreat Release Form

In exchange for participation in the activity of the Grief, Loss And Difficult Emotions Retreat led by Jon Terrell ("Jon"), of 232 S Silver Ln, Sunderland, Massachusetts, 01375 and/or use of the property, facilities and services of Jon and his assistants I agree for myself to the following:

1. I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by Jon, or the employees, representatives or agents of Jon.

2. I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself, and further release and discharge Jon for injury, loss or damage arising out of my presence upon the facilities of Jon, whether caused by the fault of myself, Jon or other third parties.

3. I agree to indemnify and defend Jon against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my use of or presence upon the facilities of Jon.

4. I agree to pay for all damages to the facilities of Jon caused by my negligent, reckless, or willful actions.

5. Any legal or equitable claim that may arise from participation in the above shall be resolved under Massachusetts or Florida  law.

I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER

UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER

CERTAIN LEGAL RIGHTS

Dated: _________________

Signature: _______________________________________

Participant (please print): ___________________________

Emergency Contact: ________________________________

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