Lis Addison
Music
Albums/Singles
Videos
Tour
Download Free Track
Kinetic Voice-KiVo
What is Kinetic Voice?
Group Classes
Private Vocal Sessions
Facilitator Courses
Testimonials
KiVo Members Only
Singing Tree Institute
Singing Tree
Maviani
Day Star
Akashic Sessions
Contact
Contact Lis
Lis Addison
Music
Albums/Singles
Videos
Tour
Download Free Track
Kinetic Voice-KiVo
What is Kinetic Voice?
Group Classes
Private Vocal Sessions
Facilitator Courses
Testimonials
KiVo Members Only
Singing Tree Institute
Singing Tree
Maviani
Day Star
Akashic Sessions
Contact
Contact Lis
Please complete the form below
Health Profile Waiver / Release
NAME
*
First Name
Last Name
EMAIL
*
ADDRESS
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
HOME PHONE
Country
(###)
###
####
CELL PHONE
Country
(###)
###
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HEALTH PROFILE
Are you taking any drugs or medications?
*
NO
YES
Have you ever been told you have heart trouble?
*
NO
YES
Do you have dizzy spell or have you had a seizure?
*
NO
YES
Do you ever experience blurred vision while exercising?
*
NO
YES
Have you experienced shortness of breath, irregular heart beat or pain in your chest as a result of exercise or vocalizing?
*
NO
YES
Do you have high blood pressure?
*
NO
YES
Are you diabetic or do you have a chronic illness?
*
NO
YES
Do you have muscle, joint or other disorder that could be aggravated by physical activity?
*
NO
YES
Do you have advice from a physician not to exercise?
*
NO
YES
Are you pregnant?
*
NO
YES
RELEASE OF LIABILITY: In exchange for participation in the activity of Practicing and Learning KiVo: The Kinetic Voice® organized by Phyllis Addison-Foster aka Lis Addison ("Lis Addison"), of 20 Meadow Drive, San Rafael, CA 94903 and/or use of the property, facilities and services of Lis Addison, I agree for myself and (if applicable) for the members of my family, to the following: 1. I agree to observe and obey all rules and warnings, and further agree to follow any oral instruction s or directions given by Lis Addison, or the employees, representatives or agents of Lis Addison. 2. I recognize that there are certain inherent risks associated with the above-described activity and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge Lis Addison for injury, loss or damage arising out of my or my family's use f or presence upon the facilities of Lis Addison, whether caused by the fault of myself, my family, Lis Addison or other third parties. 3. I agree to indemnify and defend Lis Addison 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 Lis Addison. 4. I agree to pay for all damages to the facilities of Lis Addison caused by my or my family's negligent, reckless, or willful actions. 5. Any legal or equitable claim that may arise from participation in the above shall be resolved un California law. I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.
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WAIVER / RELEASE: The health information I have provided above is accurate to the best of my knowledge. I understand that my participation in KiVo® is voluntary and at my own risk. I release KiVo and it’s assigns, heirs and successors from any consequences arising from any KiVo or KiVo related activity I participate in provided by any KiVo Trainers, Teachers or Practitioners. I hereby release KiVo and Lis Addison from any liability for any claims, demands, injuries, actions or causes of action to my person or property arising out of or connected with the use of any of the services, equipment or facilities provided by KiVo or any KiVo Trainers, Teachers or Practitioners. I further understand the activities involve physical strenuous exercise and risk of bodily injury and I accept full and complete responsibility for any activity I engage in with KiVo or any KiVo Trainer, Teacher or Practitioner. I have carefully read and completely understand the foregoing provisions and freely enter into this within agreement of the waiver/release.
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STUDENT AGREEMENT: As a KiVo student, you are in the process of learning healing tones, concepts & choreography specific to the form of KiVo®: The Kinetic Voice. These are the Intellectual Property of Lis Addison, and are not to be used in session or as healing tools with clients or students unless you are a licensed KiVo Facilitator or given verbal approval. I hereby agree to abstain from teaching, sharing, using or showing the material I learned in the KiVo Facilitator’s Training such as esoteric aspects of Vocal Chakra Healing Tones (VoCHeT®) & Body Chants® aside from that which is in the public domain in Ms. Addison’s CDs and booklets. I also abstain from teaching the choreography and proprietary names of the choreography I learn in association with the healing tones until I am a fully licensed KiVo practitioner. I agree not to share, sell, post, trade, distribute or in an other way, exhibit the KiVo videos I receive during the KiVo Training and understand these are the sole property of Lis Addison/KiVo: The Kinetic Voice who own the rights and copyrights hereunder. I agree to abide by the guidelines printed in this manual.”
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DATE
*
MM
DD
YYYY
Thank you!
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