Retreat Participation Agreement, Waiver of Liability & Assumption of Risk

Event: Clear Your Mind & Raise Your Vibration — Experiential Nature Retreat
Location: Old Man River Nature Retreat, Potosi, Missouri
Dates: May 2–3, 2026

1. Acknowledgment of Participation

I understand that I am voluntarily participating in programs, activities, and services offered by Old Man River Nature Retreat, a nonprofit organization, including but not limited to:

  • Breathwork practices
  • Incense Journey and sensory experiences
  • Sound healing and meditation
  • Zhineng / Medical Qigong
  • Systema martial arts instruction
  • Fly casting and fishing activities
  • Nature activities including hiking, lake access, and outdoor terrain use
  • Group activities such as drum circles
  • Energy, relaxation, and wellness practices
  • Educational and experiential healing sessions

I acknowledge that participation is voluntary and that all activities are optional.

2. Assumption of Risk

I understand that participation in retreat activities involves inherent risks, including but not limited to:

  • Physical exertion or injury
  • Emotional or psychological responses
  • Exposure to natural outdoor conditions
  • Uneven terrain, wildlife, and environmental hazards
  • Water-related risks associated with lake access or fishing
  • Risks associated with martial arts or movement-based practices
  • Risks related to breathwork or meditative practices

I voluntarily assume full responsibility for any risks, injuries, damages, or losses that may occur.

3. Health & Medical Responsibility

I confirm that:

  • I am physically and mentally capable of participating.
  • I am responsible for consulting a medical professional regarding my participation if necessary.
  • I will inform retreat staff of any medical or physical limitations that may affect my participation.
  • I understand that this retreat does not provide medical or psychological treatment.

I understand that wellness practices offered are educational and experiential in nature and are not a substitute for professional medical or mental health care.

4. Release of Liability

To the fullest extent permitted by law, I release and hold harmless:

Old Man River Nature Retreat, its directors, officers, staff, volunteers, practitioners, instructors, facilitators, partners, sponsors, and affiliated organizations (including supporting organizations and visiting practitioners) from any and all claims, liabilities, damages, demands, or causes of action arising from my participation, including claims related to negligence.

5. Practitioner & Instruction Acknowledgment

I understand that individual practitioners and instructors provide guidance based on their training and expertise. I agree to follow all safety instructions and take full responsibility for my level of participation.

I may withdraw from any activity at any time.

6. Property & Personal Responsibility

I am responsible for my personal belongings.
Old Man River Nature Retreat is not responsible for lost, stolen, or damaged property.

I agree to respect the retreat property, environment, and community.

7. Photo & Media Release

I grant permission for Old Man River Nature Retreat to photograph or record me during the event for educational, promotional, or nonprofit purposes without compensation.

☐ I opt out of photo/media use (check if applicable).

8. Community Conduct

I agree to maintain respectful conduct toward all participants, staff, and property.
The retreat reserves the right to remove participants for unsafe or disruptive behavior without refund.

9. Voluntary Participation & Understanding

I confirm that:

  • I have read and understood this agreement.
  • I understand the risks involved.
  • I voluntarily accept all terms.
  • I sign this agreement freely without coercion.

Participant Information

Name: ____________________________
Signature: _________________________
Date: _____________________________

Emergency Contact Name: _______________________
Emergency Contact Phone: _______________________