Relationship Registration Page – Deposit Only – The Center for Mindful Exploration

Relationship Reset and Rebuild – REGISTRATION WITH DEPOSIT ONLY

Registration for couples bundle with deposit

This field is for validation purposes and should be left unchanged.

Partner A

First Last

Phone

Partner B

First Last

Phone

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Event Deposit Only

Price:

Balance due when intial appointment is scheduled.

Total

Credit Card

Card Details

Cardholder Name

Waiver(Required)

I agree to the liability waiver

By signing this Waiver, I acknowledge that I am in good health and in proper physical and mental condition to participate in this event, and I assume all risk, and take full responsibility; waiving any claims of personal injury, disability, sickness, death, loss or damage to person or property inherent in, and/or in any way connected with participating in the event at The Center For Mindful Exploration, or unforeseeable mental, emotional, or physical challenge or disease associated with said Event, as taught by The Center for Mindful Exploration. I agree that I will fully comply with all applicable laws, ordinances, and regulations regarding the use the Event premises.

I acknowledge that the event is an exploration into many aspects of our lives and such activity is subject to mishap and even injury to participants in the form of mental, physical, or emotional upheaval, pain, and “release”. I understand and acknowledge that The Center for Mindful Exploration activities have inherent dangers at the “mental level” that no amount of care, caution, instruction or expertise can eliminate, and I expressly and voluntarily assume all risk of death or personal injury, either mental, emotional, or physical, sustained while participating in and following Center for Mindful Exploration events.

I authorize The Center For Mindful Exploration to take my photographs and to use them for advertising and marketing purposes. I understand that the photographs and all intellectual property rights of the photographs belong to The Center For Mindful Exploration and that I will receive no monetary compensation for the use of my photograph.

I have read this agreement, and I have been advised to read it carefully before signing. I am 18 years of age or older and mentally competent to enter into this waiver. I understand and confirm that by signing this WAIVER AND RELEASE I have given up considerable future legal rights. I have signed this Agreement freely, competently, voluntarily, without any inducement or assurance of any nature, and under no duress. My signature is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability to the full extent of the law, and I intend it to be a complete and unconditional release of all liability and claims.

DISCLAIMER:
The Center for Mindful Exploration events are personal development and are not a substitute for medical or psychiatric advice and treatment. It is only part of a well-rounded holistic approach to healthy living. The Center for Mindful Exploration and Workshop Events should not be used as a substitute for medical care and advice from your physician. Please contact a qualified, licensed physician for any illness or disease.