Wild & Well Detox Waiver | Happiness Retreat

Participant Information

Full Name Email Address Date of Birth Emergency Contact Name Relationship to Participant Emergency Contact Phone Number Alternative Phone Number Provincial Health Care Number

Disclaimer & Liability Waiver

The Wild & Well Detox Retreat is intended for educational, wellness, and self-care purposes only. The retreat does not provide medical diagnosis, treatment, or medical care and is not a substitute for professional medical advice, diagnosis, or treatment from a licensed healthcare provider.

The nutritional guidance, herbal recommendations, detox practices, natural healing techniques, hydrotherapy applications, mindfulness practices, movement sessions, and wellness information shared during this retreat are designed to support general well-being, relaxation, nourishment, and natural detoxification only, and are not intended to diagnose, treat, cure, or prevent any disease.

Participants are strongly encouraged to consult a qualified healthcare provider before attending the retreat, especially if they are pregnant or breastfeeding, taking medication, experiencing chronic illness, mental health conditions, diabetes, cardiovascular conditions, liver or kidney disease, eating disorders, physical limitations, allergies, or any other medical concern.

Participation in this retreat is entirely voluntary. Each participant accepts full responsibility for their own physical, emotional, mental, and spiritual well-being throughout the retreat.

Participants understand that this retreat takes place in a natural outdoor setting and on private property, which may include uneven terrain, forest paths, lakeside areas, stairs, outdoor walking, interaction with animals, campfires, movement practices, hydrotherapy applications, and other nature-based activities.

Participants acknowledge that retreat activities take place in a rural wilderness environment and may involve exposure to wildlife, insects, domestic animals, changing weather conditions, uneven terrain, water features including fluctuating water levels, campfires, and other natural hazards commonly associated with outdoor settings.

Participants acknowledge that these activities and environments carry inherent risks, including but not limited to slips, falls, injuries, allergic reactions, physical discomfort, illness, or other unforeseen incidents.

Participants agree to exercise personal care, awareness, and judgment at all times and to immediately communicate any physical discomfort, medical concern, injury, or limitation during the retreat.

By attending this retreat, participants knowingly and voluntarily assume all risks associated with participation and release Happiness Retreat and Annemieke Gardezy from liability for injuries, accidents, losses, damages, or claims arising from participation in the retreat or presence on the properties traversed, except where prohibited by law or resulting from gross negligence.

Participants understand that they are responsible for their own personal belongings, transportation, medical care, medications, and health-related decisions during and after the retreat.

This retreat is intended to support and educate, not to replace appropriate medical support when needed.

Participant Acknowledgement

Please check each box.

I have read and understood this Disclaimer, Liability Waiver, and Participant Agreement. I understand that participation in the retreat is voluntary and undertaken at my own risk. I understand that this retreat does not provide medical diagnosis, treatment, or medical care. I take responsibility for communicating any relevant health concerns, medical conditions, allergies, injuries, medications, or physical limitations that may affect my participation. I understand that retreat activities take place in a natural outdoor environment and on private and public properties, and that participation involves inherent risks. I understand that this retreat takes place in a rural and remote setting. Medical facilities are located off-site and require travel time. Emergency medical assistance may not be immediately available. I voluntarily accept responsibility for my participation and agree to exercise reasonable care for my own safety and well-being.

Medical & Emergency Consent

In the event of an accident, injury, illness, or medical emergency, I authorize Happiness Retreat and Annemieke Gardezy to contact emergency medical services and my emergency contact if deemed necessary.

I understand that any medical treatment, transportation, ambulance services, hospital care, or related expenses are my sole responsibility.

I acknowledge that retreat facilitators are not medical professionals acting in a healthcare capacity and are not responsible for providing medical diagnosis or treatment.

I have read and understood this Medical & Emergency Consent section.

Photography & Media Release

From time to time, photographs or videos may be taken during retreat activities for educational, promotional, or marketing purposes.

Please select one.

Yes, I give permission for photographs and/or videos that may include my image to be used by Happiness Retreat. No, I do not give permission for photographs and/or videos that may include my image to be used.

I understand that I may notify the retreat facilitator at any time if I prefer not to have my image appear in group photographs or recordings.

Participant Initials

Certification & Electronic Signature

I certify that the information provided in this document is accurate and complete to the best of my knowledge.

I confirm that I am at least 18 years of age and that I have read, understood, and agree to the terms outlined in this Disclaimer, Liability Waiver, and Participant Agreement.

Participant Signature Printed Name Date

I agree that an electronic signature, typed name, digital signature, or signed electronic copy of this document shall have the same legal effect as an original handwritten signature.

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