READ CAREFULLY - THIS AFFECTS YOUR LEGAL RIGHTS

In exchange for participation in the activity of Existential Coaching organized by Kathryn Rivers, of 2822 22nd Street, San Francisco, California, 94110 and/or use of the property, facilities and services of Kathryn Rivers, I, _________________, of _________________, _________________, _________________ _________________, agree for myself and (if applicable) for the members of my family, to the following:

1. AGREEMENT TO FOLLOW DIRECTIONS. I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by Kathryn Rivers, or the employees, representatives or agents of Kathryn Rivers.

2. ASSUMPTION OF THE RISKS AND RELEASE. I recognize that the above described activity is NOT psychotherapy but does involve the exploration of personal, emotional, and psychological issues and that there may be risks associated with such exploration. I recognize that these risks may include, but are not limited to, emotional discomfort, anxiety, depression, and other negative feelings, outcomes, and certain inherent risks associated with the above described activity. Further, I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge Kathryn Rivers for injury, loss or damage arising out of my or my family's use of or presence upon the facilities of Kathryn Rivers, whether caused by the fault of myself, my family, Kathryn Rivers or other third parties.

3. INDEMNIFICATION. I agree to indemnify and defend Kathryn Rivers against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family's use of or presence upon the facilities of Kathryn Rivers.

4. FEES. I agree to pay for all damages to the facilities of Kathryn Rivers caused by any negligent, reckless, or willful actions by me or my family.

5. APPLICABLE LAW. Any legal or equitable claim that may arise from participation in the above shall be resolved under California law.

6. NO DURESS. I agree and acknowledge that I am under no pressure or duress to sign this Agreement and that I have been given a reasonable opportunity to review it before signing. I further agree and acknowledge that I am free to have my own legal counsel review this Agreement if I so desire. I further agree and acknowledge that Kathryn Rivers has offered to refund any fees I have paid to use its facilities if I choose not to sign this Agreement.

7. ARM'S LENGTH AGREEMENT. This Agreement and each of its terms are the product of an arm's length negotiation between the Parties. In the event any ambiguity is found to exist in the interpretation of this Agreement, or any of its provisions, the Parties, and each of them, explicitly reject the application of any legal or equitable rule of interpretation which would lead to a construction either "for" or "against" a particular party based upon their status as the drafter of a specific term, language, or provision giving rise to such ambiguity. Accordingly, the Parties specifically reject the application of Cal. Civ. Code §1654 to this Agreement, as well as any other statute or common law principles of similar effect.

8. ENFORCEABILITY. The invalidity or unenforceability of any provision of this Agreement, whether standing alone or as applied to a particular occurrence or circumstance, shall not affect the validity or enforceability of any other provision of this Agreement or of any other applications of such provision, as the case may be, and such invalid or unenforceable provision shall be deemed not to be a part of this Agreement.

9. EMERGENCY CONTACT. In case of an emergency, please call _________________ (Relationship: _________________) at _________________ (Day), or _________________ (Evening).

I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.

By: ____________________ (Print Name)

Date: ___________________

SIGN___________________