Activity Waiver Legal Release Form

INFORMED CONSENT FOR PARTICIPATION, ACTIVITY WAIVER LEGAL RELEASE, *

THIS ACTIVITY WAIVER AND RELEASE (this “Agreement”) dated this __/__/20__.

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Consideration 1 & 2: *

1. Being of lawful age and in consideration of being permitted to participate in the activity described below, the Participant releases and forever discharges The "Activity Provider(s)" BodyWork Health Practitioner(s) Novum LL Bliss LLC / Aum Body Bliss LLC c/o Novum LaLuna LMT., The Releasee(s), and/or The "Activity Provider(s)" BodyWork Health Practitioner(s) Novum LL Bliss LLC / Aum Body Bliss LLC c/o Novum LaLuna LMT., The Releasee(s) spouse, heirs, executors, administrators, employees, company, llc, legal representatives and assigns from all manner of actions, causes of action, debts, accounts, bonds, contracts, claims and demands for or by reason of any injury to person or property, including injury resulting in the death of the Participant, which has been or may be sustained as a consequence of the Participant’s participation in the activity described below, and notwithstanding that such damage, loss or injury may have been caused solely or partly by the negligence of The "Activity Provider(s)" BodyWork Health Practitioner(s) Novum LL Bliss LLC / Aum Body Bliss LLC c/o Novum LaLuna LMT., The Releasee(s). 2. The Releasor understands that the Releasor would not be permitted to participate in the activity described below unless the Releasor signed this Agreement.

YES, I understand and accept Consideration Agreement 1 & 2.

NO, I do not understand and accept Consideration Agreement 1 & 2.

Details Of Activity 3: *

3. The Participant will participate in the following activity:

Complementary Alternative Medicine Massage Therapy All Inclusive Clinical Corrective Bodywork, which may include Ashiatsu Floor and Ashiatsu Bar "Formal" and/or "Complimentary Student Clinic Promotional Offering(s) Valid For A Limited Time Upon Approval Only", and/or receiving valuable quality service(s), activity(ies), content(s), good(s), event(s) and offering(s) provided by "Activity Provider(s)" BodyWork Health Practitioner(s) Novum LL Bliss LLC / Aum Body Bliss LLC c/o Novum LaLuna LMT., The Releasee(s).

Concurrent Release 4: *

4. The Participant acknowledges that this Agreement is given with the express intention of effecting the extinguishment of certain obligations owed to the Participant, and with the intention of binding the Participant’s spouse, heirs, executors, administrators, legal representatives, and assigns.

YES, I understand and accept Concurrent Release Agreement 4.

NO, I do not understand and accept Concurrent Release Agreement 4.

Fitness To Participate 5: *

5. The Participant acknowledges and agrees that the Participant does not have any major, serious, severe, life-threatening, physical limitation(s), medical ailment(s), physical or mental disability(ies) that would limit, cause or do more harm than good, or prevent the Participant from participating in the above-mentioned activity(ies). The Participant acknowledges and agrees to divulge any and all health issue(s), contraindication(s), condition(s), medication(s) that require special attention and if required, to obtain a physician(s) medical examination and clearance to participate. The Participant acknowledges and agrees that the Participant is following and adhering to all physician(s) diagnosis(ses), prescription(s), treatment(s), medication(s) per physician(s) guideline(s) that pertain to the Participant's health or medical management. The Participant acknowledges and agrees that should the "Activity Provider(s)" BodyWork Health Practitioner(s) Novum LL Bliss LLC / Aum Body Bliss LLC c/o Novum LaLuna LMT., find any sign(s), indication(s), concern(s), contraindication(s) that have cause for informed assumption(s) of a potential suspect of communicable disease(s) or highly infectious disease(s) is cause for termination and extinguishment of the Participant from participation in the prevention of spreading contaminant(s), or outbreak(s), or cause(s) to Other Participant(s), or to the "Activity Provider(s)" BodyWork Health Practitioner(s) Novum LL Bliss LLC / Aum Body Bliss LLC c/o Novum LaLuna LMT. The Participant acknowledges and agrees that by submitting this Activity Waiver Legal Release, The Participant acknowledges and agrees that the Participant has no communicable disease(s) and/or highly infectious disease(s) and is SAFE to participate and that the Participant is not a threat to the Participant itself, or to Other Participant(s), or to the "Activity Provider(s)" BodyWork Health Practitioner(s) Novum LL Bliss LLC / Aum Body Bliss LLC c/o Novum LaLuna LMT.

YES, I understand and accept Fitness To Participate Agreement 5.

NO, I do not understand and accept Fitness To Participate Agreement 5.

Full And Final Settlement 6, 7, 8, & 9: *

6. The Participant hereby acknowledges and agrees that the Participant has carefully read this Agreement, that the Participant fully understands the same, and that the Participant is freely and voluntarily executing the same. 7. The Participant understands that by signing this Agreement, the Participant agrees to be forever prevented from suing or otherwise claiming against the "Activity Provider(s)" BodyWork Health Practitioner(s) Novum LL Bliss LLC / Aum Body Bliss LLC c/o Novum LaLuna LMT., The Releasee(s) for any property loss or personal injury that the Participant may sustain while Participating in or preparing for the above noted activity. 8. The Participant has been given the opportunity and has been encouraged to seek independent legal advice prior to signing this Agreement. 9. This Agreement contains the entire agreement between the parties to this Agreement and the terms of this Agreement are contractual and not a mere recital.

YES, I understand and accept Full And Final Settlement Agreement 6, 7, 8, & 9.

NO, I do not understand and accept Full And Final Settlement Agreement 6, 7, 8, & 9.

Governing Law 10: *

10. This Agreement will be construed in accordance with and governed by the laws of the State of Vermont.

YES, I understand and accept Governing Law Agreement 10.

NO, I do not understand and accept Governing Law Agreement 10.

Date *

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