I voluntarily consent to participate in the program. I understand this program is educational in nature and not psychotherapy or a substitute for psychotherapy.

I understand that the program may involve physical, mental, intellectual, and emotional activity, including exercises that may tax my physical, intellectual, mental and emotional capacity. I understand and acknowledge that my participation in the program and every separate part of it is purely voluntary and that at all times I will be free to choose NOT to participate in any part or all of the event. I acknowledge my responsibility for exercising my judgment and initiative in choosing what parts of the event I will participate in. I acknowledge that my choices and my actions may pose a risk of injury to myself or others. By this consent, I knowingly and voluntarily assume the risk of injury either to myself or caused to others by me in the program. I release Doug Dane Consulting Inc., its officers, directors and staff, and Doug Dane from any and all liability for injuries to myself. I agree to hold harmless Doug Dane Consulting Inc., its officers, directors and staff and Doug Dane and any of his companies from any and all liability for injuries to myself and for any injury to others caused by me.

I take responsibility for consulting with a medical doctor and/or psychotherapist prior to participating in the program concerning any known or potential physical, mental or emotional condition which I have or may have, and will ask for medical and/or psychotherapeutic permission to participate. I assume the risk, by this consent, of any physical or other injury, illness or conditions during the event, and hereby release Doug Dane Consulting Inc., its officers, directors and staff, and Doug Dane and his companies from any and all liability therefore.

I am aware that all events (in person or online) that I am participating in will be recorded, in either or both audio and video formats. I am aware that my image, voice, likeness, name, interview or performance may become part of a future Audio/Video program. I authorize Doug Dane and/or Doug Dane Consulting Inc. to record and use these audio and video components as they wish.

Doug Dane Consulting Inc. and/or Doug Dane shall own all rights, title, and interest in and to the program, voice and/or picture, and same may be recorded on or transferred to videotape, film, slides, photographs, audio tapes, or other media, to be used and disposed of without limitation as Doug Dane and/or Doug Dane Consulting Inc. shall determine.

I understand that this material may be used for educational and promotional purposes as well as to assist and heal other people who may share similar issues as those I discuss at this event.