Ngakpa International Liability Form

Name*

FirstLast

Address

Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry

Email*

Phone*

I UNDERSTAND that Ngakpa International (NI) offers instruction in Buddhism, Yoga, Ayurveda, Meditation, and related activities through various classes, workshops, trainings, etc. Initial below to indicate that you understand and agree.*

I UNDERSTAND that I must know my own capabilities and take full responsibility for not exceeding my limitation in the practices and classes. Initial below to indicate that you understand and agree.*

I AM ALSO RESPONSIBLE for informing the instructors of any medical condition(s), physical or psychological, that may affect my ability to participate in any way, in any activity, of Ngakpa International. Initial below to indicate that you understand and agree.*

I ACKNOWLEDGE that no specific benefits or results have been promised or assured me resulting from my participation in any of the classes, workshops, or practices offered by Ngakpa International. Initial below to indicate that you understand and agree.*

I HEREBY freely and voluntarily assume any and all risks, risk of injury or physical discomfort, loss or damage associated with my participation in such activities. I agree to protect, indemnify and save harmless Ngakpa International and their authorized agents, from and against any and all expenses, damages, claim, suit, actions, judgments, fees, and costs whatsoever, including reasonable attorneys’ fees and costs, witness fees and per diem, relating to or arising out of or in any way connected with, actions or omissions of Ngakpa International , it’s agents, or any claim or defense of any claim that relates to performance by Ngakpa International , it’s employees, agents, and/or representatives under the Agreement, or failure to comply with any terms of the Agreement, and /or their legal obligations, or any claim or action for personal injury, death, or other cause of action involving participant, provided that Ngakpa International shall be given prompt notice of any such action or claim. Initial below to indicate that you understand and agree.*

I HEREBY waive and release any claim(s) that I, or any third parties acting on my behalf or on their own behalf, may have at any time, now or in the future, for any physical and/or psychological injury, against Ngakpa International or any person(s), agent(s), and/or representative(s), or entity in any way involved therewith. Initial below to indicate that you understand and agree.*

I HEREBY waive and release the right of any photographs and video footage of myself that may be taken during any retreat or NI activity to NI for use at their discretion. Initial below to indicate that you understand and agree.*

I HAVE carefully read and fully understand this Agreement and Release, and accept the stated terms and conditions. I have been given the opportunity to ask questions and/or consult an attorney and /or medical doctor of my choice prior to signing this form. Initial below to indicate that you understand and agree.*

Please upload a recent picture of yourself.*

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