While training at Dance Brave with Tiffany Chambers-Goldberg:

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I understand that physical exercise can be strenuous and subject to risk of serious injury. You are urged to obtain a physical examination from a doctor before participating in any exercise activity.

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I recognize that such physical activity and exertion may be difficult and strenuous and may cause or aggravate a physical injury or medical condition.

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I agree that I engage in any physical exercise or activity, I do so entirely at my own risks.

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The client acknowledges entering a professional relationship with Tiffany Chambers-Goldberg/Dance Brave for either Somatic Movement, Erotic Embodiment, Yoga, Yoga Tune Up, Structural Integration, psychedelic sitting.

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Disclaimer Regarding Licensure and Scope of Practice:

It is understood that Tiffany Chambers-Goldberg/Dance Brave is not a licensed psychotherapist, psychologist, medical doctor, or other licensed mental health professional. The services are not intended to diagnose, treat, or cure any mental health or medical conditions, and should not replace professional medical or mental health care. It is also acknowledged that Somatic Movement and Erotic Embodiment are currently an unregulated industry, and Tiffany Chambers-Goldberg/Dance Brave is not licensed by any state. For legal purposes, services are considered provided in North Carolina.

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Client Responsibilities:

The client agrees they are fully responsible for their well-being during and after sessions, including their choices and decisions. These services are not a substitute for therapy or treatment. It is understood that the services may require personal effort and experimentation, and the client takes full responsibility for any risks involved. The client acknowledges and assumes all risks associated with participation, including potential physical, mental, and emotional harm. Any advice or guidance is for informational and educational purposes only and not a guarantee of specific outcomes. It is acknowledged that results vary, and the client is responsible for implementing strategies.

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Confidentiality:

It is understood that conversations are confidential, except when disclosure is required by law, such as in cases of suspected abuse, threats of harm, or court orders.

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Agreement:

By signing, it is confirmed that the Waiver of Liability and Informed Consent has been read, understood, and agreed to. The client is voluntarily engaging in services with full knowledge of the disclaimers and limitations.

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This waiver and release of liability includes, without limitation, that the client waives any claims against the practitioner for damages arising from the psychedelic experience, except in cases of gross negligence or intentional misconduct at any injuries which may occur as a result of:

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(a) Your participation in any activity or training session and

(b) Instruction, training, supervision by your instructor while at Dance Brave.

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You acknowledge that you have carefully read this "waiver and release" and fully understand that it is a release of liability. You expressly agree to release and discharge the Instructor at Dance Brave; fitness from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against your Fitness/Dance/Pole Instructor for personal injury or property damage.

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To the extent that statute or case law does not prohibit release for negligence, this release is also for negligence on the part of the Dance/Pole Instructor. If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to the invalid, then the remained of this release from liability shall remain in full force and effect and the offending provision or provisions severed herefrom. 

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By signing this release, I acknowledge that I understand its content and that this release cannot be modified orally.

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