Health Retreat / Scalar Consent Waiver — Harmony@Home

Participation

I choose to participate in the above health retreat offered by Suzanne Salvador, Harmony@Home and any of our staff member including other individual/group activities listed on the retreat agenda that I have received.

Physical Responsibility

I understand that it is my responsibility to participate in classes, outdoor walks, hiking or other physical movement activities to be sure that I am physically capable to participate.

Detoxification Awareness

I recognize that participating in lymphatic drainage, microcurrent, scalar energy treatments may cause detoxification symptoms. I am fully aware that there are possible discomforts and temporary detox effects involved in participating.

Assumption of Liability

I agree to assume full responsibility for any injuries sustained during this physical activity and I release Suzanne Salvador, Harmony@Home and any of our staff member from all liability because of my participation in nourished fast and the retreat agenda.

Assumption of Risks

In consideration of my participation in this Program, Cold Thermogenesis/Immersion may involve physiological responses such as increased heart rate, blood pressure changes, breathing difficulties, hypothermia, and shock. I acknowledge that this Program involves various risks, dangers and hazards which all participants are required to assume, including but not limited to:

• Nausea and vomiting.
• Muscle aches and pains.
• Anxiety.
• Interrupted Sleep.
• Sweating.
• Irritability.
• Headaches.
• Physical injury; slips, falls, frostbite.

I understand that participation is voluntary and participants may exit at any time.

Medical Disclaimer & Health Conditions

I understand that the Program/Retreat is not medically supervised or a substitute for medical advice. I acknowledge and warrant that I am physically fit and do not have medical conditions which would prevent my participation. I understand that the Electro Lymphatic, Microcurrent and Scalar Energy Therapy I receive is provided for the basic purpose of relaxation, improving the flow of my lymphatic system, improve micro circulation and help restore cellular communication and our body's natural healing mechanisms. For your safety and well-being, some conditions will require a note from your doctor, or consultation with your referring provider, before proceeding.

I state:

• I am over 18 years of age and I am in general good health.
• I do not have an electronic device such as a pacemaker.
• I have not had surgery or an organ transplant.
• I am not on life support.
• I do not have rods, pins, head coils, staples or stents.
• I do not have major cardiac problems.
• I do not take blood thinner.

Safety Protocols and Compliance

I agree to follow all safety guidelines and instructions provided by Suzanne Salvador, Harmony@Home and any of our staff member.

Release of Likeness

I hereby give Suzanne Salvador, Harmony@Home and any of our staff member permission to use photographs or videos taken during the event for promotional or educational purposes.

Consent to Medical Treatment

I agree to hereby give permission to have Suzanne Salvador, Harmony@Home and any of our staff member arrange for any emergency medical care including hospitalization and transportation, if necessary, to the administration of such emergency medical treatment as may be deemed necessary in the circumstances. I agree to pay all costs associated with medical care and transportation.

Release of Liability and Hold Harmless Clause

In consideration of being granted permission to participate in the above noted Program, I hereby for myself, my heirs, executors, administrators, or any others who may claim on my behalf, covenant not to sue, and hereby waive, release and discharge Suzanne Salvador, Harmony@Home and any of our staff member from any and all claims of liability for personal injury, illness, loss of life or property damage of any kind or nature, arising out of or sustained in the course of my participation.

Indemnity

In consideration of being granted permission to participate in the above noted Program, I agree to hold harmless and indemnify Suzanne Salvador, Harmony@Home and any of our staff member from any and all liability, loss, claims, demands, costs and expenses, including reasonable legal fees, due to any personal injury or property damage to any third party arising from my participation as a participant in the Program.