Emergency Contact (First name, last name, relationship)

Emergency Contact (phone number)

Below is a retreat waiver. Please sign it by typing your first and last name in the box below. The individual electronically signing this form by typing my name (referred to as “I” or “me“) desires to attend a meditation retreat (the “Activity“) provided by Mahnamana Psychotherapy and Meditation, PC, a California professional corporation, and Elephant Dharma, a Tennessee-based nonprofit (the “Companies“). All actions I take in connection with such retreat by the Companies shall be considered the Activity. In consideration of being permitted by the Companies to participate in the Activity, I agree to all the terms and conditions set forth in this document (this “Release“). I agree to personally accept any and all risks associated with this retreat, occurring before, during, or after the retreat. I understand that teachers may help make a spreadsheet suggesting a possible carpool choice that I can make. I know that teachers may not know other drivers or passengers, that drivers and passengers are not affiliated with, agents of, or working on behalf of the teachers, and teachers hold no liability for actions or negligence of drivers or passengers. I am aware that while the Companies are taking precautions against transmission of disease, it is of course still possible that I will catch a contagious disease, including Covid-19, while on the retreat, and I personally accept all such risks and release the Companies from any claims related to the same. I understand that Tucker Peck is working in his capacity as a meditation teacher, not a psychologist, and that he is not providing psychological or medical advice. If I need treatment for mental health concerns or any other reason, I will seek out a healthcare professional licensed in my area. I have sufficiently educated myself and requested sufficient information from the teachers on the benefits and risks of the Activity. I understand that Upali and Tucker are functioning as teachers while I rent a room from a facility, and that I am responsible for my own safety and wellbeing. I AM AWARE AND UNDERSTAND THAT THE ACTIVITY IS A POTENTIALLY DANGEROUS ACTIVITY. I ACKNOWLEDGE THAT ANY INJURIES THAT I SUSTAIN MAY RESULT FROM OR BE COMPOUNDED BY THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF THE COMPANIES. NOTWITHSTANDING THE RISK, I ACKNOWLEDGE THAT I AM KNOWINGLY AND VOLUNTARILY PARTICIPATING IN THE ACTIVITY WITH AN EXPRESS UNDERSTANDING OF THE DANGER INVOLVED AND HEREBY AGREE TO ACCEPT AND ASSUME ANY AND ALL RISKS OF INJURY, DISABILITY, DEATH, PROPERTY DAMAGE, OR OTHER DAMAGE OF ANY KIND ARISING FROM THE ACTIVITY, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF THE COMPANIES OR OTHERWISE. I hereby expressly waive and release any and all claims which I may have, or which I may hereafter have, whether known or unknown, against the Companies, and its officers, directors, managers, employees, contractors, consultants, representatives, agents, affiliates, owners, successors, and assigns (collectively, “Releasees“), including without limitation Tucker Peck and Paul Peterson (AKA Upasaka Upali), arising out of, related to, or attributable to the Activity, whether arising out of the ordinary negligence of the Companies or any Releasees or otherwise. I covenant not to make or bring any such claim against the Companies or any other Releasee, and I forever release and discharge the Companies and all other Releasees from liability under such claims. This waiver and release does not extend to claims for gross negligence, intentional or reckless misconduct, or any other liabilities that California law does not permit to be released by agreement.I understand that by signing this release, I am waiving any and all claims, of any kind arising out of or attributable to the Activity, including those claims that may be unknown to me, or which I do not suspect to exist at this time. WITH THE INTENTION OF WAIVING ALL UNKNOWN AND UNSUSPECTED CLAIMS, I HEREBY EXPRESSLY WAIVE ALL RIGHTS, BENEFITS, AND PROTECTIONS I MAY HAVE UNDER CALIFORNIA CIVIL CODE SECTION 1542, WHICH READS AS FOLLOWS:A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party. I shall defend, indemnify, and hold harmless the Companies and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including attorney fees, fees, the costs of enforcing any right to indemnification under this Release, and the cost of pursuing any insurance providers, incurred by the Companies or any other Releasees arising out of or resulting from any claim of a third party related to my participation in the Activity, including any claims arising out of my own negligence or the ordinary negligence of the Companies. This Release constitutes the sole and entire agreement between the Companies and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Release is held invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Release or invalidate or render unenforceable such term or provision in any other jurisdiction, and such term shall be enforced to the maximum extent allowed by law. This Release is binding on and shall inure to the benefit of the Companies and me and their respective heirs, successors, and assigns. All matters arising out of or relating to this Release shall be governed by and construed in accordance with the internal laws of the State of California without giving effect to any choice or conflict of law provision or rule (whether of the State of California or any other jurisdiction). Any claim or cause of action arising under this Release may be brought only in the state courts located in Alameda County, California and I hereby consent to the exclusive jurisdiction of such courts. BY ELECTRONICALLY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTOOD ALL OF THE TERMS OF THIS RELEASE AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE COMPANIES FOR CLAIMS, WHETHER KNOWN OR UNKNOWN, ARISING OUT OF THE ACTIVITY.