"*" indicates required fields Kathleen Keller is a Certified TRE® Provider, under Keller Method Vitality Inc., (hereafter referred to as KMV). In consideration of my being allowed to participate in any way to learn TRE® in-person or virtual sessions, including private or group sessions, in-person or virtual lecture, workshop and/or any TRE® related events and activities, I the undersigned acknowledge, appreciate, and agree to the following: In-person instruction: Learning TRE® may involve KMV having hands-on contact with me. This includes body position modifications/corrections, and/or assistance to help facilitate the process. It is my responsibility to inform KMV if physical contact is not desirable. Virtual instruction: For safety reasons during my first TRE session, I agree to supply KMV with the name and contact number of a trusted person who will be nearby and easily reached. I will provide this information on the KMV - TRE® Intake form. KMV is not a medical health professional and is not treating any psychological or physical condition(s) that I may have. The information that I learn is not intended to diagnose, treat, cure or prevent any disease. It is my responsibility to seek an opinion from my medical physician or health care provider before doing TRE®. KMV assumes no responsibility for the use of the information and the method. I have listed all my current known medical conditions on the TRE® intake form and I will keep KMV informed about my health. If I have ANY concerns about my ability to utilize the TRE® techniques safely, I will tell KMV immediately. Private Sessions: Everything discussed within the confines of my time together with KMV shall remain confidential and will not be divulged to any third party without my expressed permission. Group Sessions: If I am participating, no identifying information will ever be divulged outside the Group which includes all participants, KMV and any assistants sub-contracted to assist in group trainings. I accept and acknowledge that I am NOT qualified to lead others through TRE® and that I will use this information only for myself. I knowingly and freely assume all risks of my participation in the programs of KMV and I assume full responsibility for my participation. I willingly agree to comply with the stated and customary terms and conditions for participation. However, if I observe any unusual significant hazard during my participation, I will remove myself from participation and bring such to the attention of KMV immediately. I for myself and on my behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless KMV and its officers, directors, shareholders, employees, partners, associates, host sites, apprentices, assistants, other employees, other participants, contractors, owner and lessors of the premises in which the activities take place (“releasees”), with respect to any and all injury, disability, death, or loss of damage to person or property. I have read this release of liability and assumption of risk agreement and fully understand its terms. I understand that i have given up substantial rights by signing it, and sign it freely and voluntarily with out any inducement.Your Name* Date* MM slash DD slash YYYY Signature*
