I understand that the activities in which I may participate in while at Back Forty Farms through NeuroBalanced, but are not limited to: Brain-Wave Optimization, Infrared Light Therapy, Horse Therapy, meditation, and relaxation methods. I certify that, to the best of my knowledge, I am physically capable of participating in the activities above and have the basic skills necessary to participate in the activities so that my participation will not pose any undue risk to my health and safety, or the health and safety of others.
In the event that I am in need of medical treatment and am unable to consent to or arrange for such treatment, I consent to the administration of any medical treatment deemed necessary by a licensed health professional, and to my transfer to any hospital reasonably accessible. I understand and agree that NeuroBalanced and Back Forty Farms, do not assume responsibility for any injury or damage that might arise out of or in connection with such authorized emergency medical treatment. I understand that this consent and certification is valid unless revoked, in writing, by me.
This information will be kept between the above mentioned parties, and is not to be released to any outside persons, organizations or agencies except in circumstances where required by law.
I assume all risks and hazards incidental to the conduct of the activities and transportation to and from all sessions. In case of injury to myself or others en route to Back Forty Farms, I hereby waive all claims against the organizers, the sponsors, companies, the staff, or any other persons appointed by them.
I agree to hold harmless and indemnify Back Forty Farms and NeuroBalanced from any and all claims, liability, and responsibility during my session. I am freely, knowingly and voluntarily entering into this Release.
I have read, understand, and agree to this release form and I have completed it honestly and accurately to the best of my knowledge and agree with all conditions therein. My signature below confirms my agreement and understanding of the release form.