I attest that:
I acknowledge the following:
I hereby release and agree to hold Rogue River Counseling harmless from, and waive on behalf of myself any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the counseling practice, or that may otherwise arise in any way in connection with any services received from Rogue River Counseling. I understand that this release discharges Rogue River Counseling from any liability or claim that I, my heirs, or any personal representatives may have against the practice with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Rogue River Counseling. This liability waiver and release extends to the counseling practice together with all therapists and other employees.