Please read the following agreement carefully before booking your Welcome Call with Rivky Gross. By booking this session, you acknowledge and agree to the terms outlined below. 

• This session is not therapy and is not a replacement for therapy.
• You understand that this session may be emotionally activating.
• You agree to pay the full amount of $350 for this session prior to the call.
• Once you join the session, it is non-refundable.
• If you do not attend or complete the session, payment is still due in full.

RELEASE OF LIABILITY AND ASSUMPTION OF RISK and CONFIDENTIALITY AGREEMENT

The individual named below (referred to as "I" or "me") desires to participate in a Welcome Call (the "Activity") provided by Rivka Gross, (the "Provider"). In consideration of being allowed to participate in said Activity and in recognition of the Provider's reliance hereon, I agree to all the terms and conditions set forth in this instrument (this "Release").

I ACKNOWLEDGE THAT THE ACTIVITY IS NOT PSYCHOTHERAPY OR REPLACEMENT FOR PSYCHOTHERAPY. I ACKNOWLEDGE THAT I AM VOLUNTARILY PARTICIPATING IN THE ACTIVITY WITH KNOWLEDGE OF THE DANGER INVOLVED AND HEREBY AGREE TO ACCEPT AND ASSUME ANY AND ALL RISKS OF PHYSICAL AND/OR PSYCHOLOGICAL INJURY, DISABILITY, DEATH, AND/OR PROPERTY DAMAGE ARISING FROM MY PARTICIPATION IN THE ACTIVITY, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF THE PROVIDER OR OTHERWISE.

I hereby expressly waive and release any and all claims, now known or hereafter known, against the Provider, or anyone else involved or participating in the Activity (the “Participants”), on account of physical or psychological injury, disability, death, or property damage arising out of or attributable to my participation in the Activity, whether arising out of the ordinary negligence of the Provider or any other Participants or otherwise. I covenant not to make or bring any such claim against the Provider or any other Participant, and forever release and discharge the Provider and all other Participants from liability under such claims. This waiver and release does not extend to claims for gross negligence, willful misconduct, or any other liabilities that NJ law does not permit to be released by agreement.

I shall defend, indemnify, and hold harmless the Provider and all other Participants against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including attorney fees, fees, the costs of enforcing any right to indemnification under this Release, and the cost of pursuing any insurance providers, arising out or resulting from any claim of a third party related to my participation in the Activity, including any claim related to my own negligence or the ordinary negligence of the Provider.

This Release constitutes the sole and entire agreement of the Provider and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Release is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Release or invalidate or render unenforceable such term or provision in any other jurisdiction. This Release is binding on and shall inure to the benefit of the Provider and me and their respective successors and assigns. All matters arising out of or relating to this Release shall be governed by and construed in accordance with the internal laws of the State of NJ without giving effect to any choice or conflict of law provision or rule (whether of the State of NJ or any other jurisdiction). Any claim or cause of action arising under this Release may be brought only in the federal and state courts located in Ocean County, NJ and I hereby consent to the exclusive jurisdiction of such courts.

I further agree that all that is said during the Activity including information disseminated by Provider or Participants during the Activity or on the Whatsapp chat or in connection with the Activity will be kept confidential. 

I agree not to transmit share or disseminate any information gleaned from the Activity without prior written consent from Provider and/or Participants. (I will not share anything I have learned in this group without permission from Rivka Gross, and without crediting Rivka Gross)

Waiver & Contract

I know that this container is not therapy, nor is it a substitute for therapy. I am responsible for my own mental health and if I am in need of any professional or medical help, I will seek it out.

I understand that Rivka Gross is not my therapist, 

I understand that this work may be emotionally stimulating, and I will not hold Rivka Gross responsible for my emotional wellbeing.

I understand that Rivka Gross promises to hold confidential any information I share with them in the sessions, unless I have communicated through written consent that it's okay to communicate with a therapist or coach.

I understand that Rivka Gross can not promise any results. What I put into this container is what I will get out of it. I understand my personal growth is my own responsibility.

I understand that I will pay the fee of the container, prior to the container, unless a payment plan is otherwise discussed.

I understand that since the scheduling of an appointment involves the reservation of time specifically for me, any changes in appointment time must be made within 48 hours of the scheduled appointment, or I will forfeit my session.

I understand this work is not a fit for people with complex PTSD, psychosis,active addiction, biological disorders like Autism, personality disorders, or suicidality.

I understand that Rivka Gross has the right to refuse service for any reason at any time, especially if they feel that the work is not the right fit for my condition. If I am refused service, I will be issued a full refund.

I understand that if I have any questions about this form I will clarify with Rivka Gross before signing, and with signing I agree to all of the above.

BY CLICKING THE BOX, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS RELEASE AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE PROVIDER.