Student Safety and Liability Agreements


These are the agreements that our students sign before the start of the therapist training courses. We've put them on the web so that prospective students can read them before committing to talking the training. There are several, very important conditions to the material being taught, and they should be considered before starting the training. In addition, we do not accept students with certain medical or psychological conditions that would make it unsafe for them to attend the workshop - as is covered in the form that has the student 'List any potentially dangerous health conditions' below. We rarely tape or video the courses, but if so, students are encouraged to decide if they would be willing to allow us to film or record them - it isn't required for the class. It just helps other people who might be able to learn from the student's experience.



Therapist Training
HEALTH HISTORY
Revision 1.0

IF YOU HAVE ANY POTENTIALLY SERIOUS PHYSICAL OR MENTAL HEALTH PROBLEMS OR ISSUES (LIKE CHEST PAIN, SUICIDAL FEELINGS, BIPOLAR DISORDER, HEART CONDITIONS OR DEPRESSION), LET US KNOW IMMEDIATELY AND LIST IT ON THIS FORM! We suggest that people with a heart condition NOT take the workshop, just in case (we will give a full refund). Also, if you have any physical conditions that might make these processes difficult to do, or might make your condition worsen, please let us know on this form (such as diabetes, back injuries, etc.). If this is the case, we expect you to work with your physician both before and after the workshop to be sure your condition doesn't worsen.













Signed by: __________________________________________________________________



Print Name: _________________________________________________________________



Date: _______________________________________________________________________



Witnessed by: ________________________________________________________________



Print Name of Witness: ________________________________________________________



Therapist Training
RELEASE OF LIABILITY AGREEMENT
Revision 2.1

Intent: The material that you will be learning is state of the art and still very experimental. Long-term effects, if any, have not been studied or researched. Thus, we cannot guarantee that you or the people you work with will not have some sort of adverse reaction that we did not anticipate. If you are not willing to take full and complete responsibility for what happens by using our material we require that you not start with the training or private session, and a full refund excluding deposit will be returned to you if one was made. This is all common sense given the nature of our material, but we want to make it perfectly explicit up front.

I (Print name),


located at the address,



do agree to the following:
  1. I take complete responsibility for my own emotional and/or physical well being both during and after this workshop or private session.
  2. As a therapist, I agree to instruct others whom I help with the Institute techniques to take complete responsibility for their emotional and/or physical well being.
  3. I agree to hold harmless the Institute For The Study of Peak States, anyone associated with the Institute now, in the past or in the future, and anyone else involved with these Institute techniques from any claims made by anyone whom I seek to help with these techniques including myself.
  4. As a layperson I will use the techniques under the supervision of a qualified therapist or physician as legally appropriate.
  5. As a therapist I will use the techniques only if I have previous adequate trauma therapy experience and safety training.
  6. I will not use these techniques to try to solve a problem where common sense would tell me that it is not appropriate.
  7. I understand that my class may include experimental techniques or processes. I will use these with clients only after becoming certified by the Institute and signing a license agreement with the Institute.

Signed:


Date:


Witness (Print and sign name):



Therapist Training
RELEASE OF VIDEO RIGHTS
Revision 1.1

Intent: We plan on video and audio taping the Peak States workshop you are participating in. We hope to make this into demonstration videos and training material. By signing this document, you are giving us permission to use the video footage and sound that may include your participation. If there is any particular portion of the workshop that you don’t want seen by others, you need to let us know the day it is filmed, else your permission is assumed. Please note that at the bottom of this form. Thanks!



I,



located at the address,




do agree to releasing any rights to the material video or sound taped in this peak states workshop.



Signed:


Date:


Witness: