Forms

PLEASE COMPLETE ALL 4 SECTIONS BELOW:

Release: I understand that Serenity Vista Inc. is NOT a medical facility and does NOT provide medical treatment or care of any sort. Serenity Vista is a retreat that also provides counseling and other retreat programs and activities such as yoga, massage, music and art. I understand that visiting Serenity Vista is not a substitute for medical or psychiatric treatment or care. I am responsible for my own medical care and willingly declare my commitment to completely abstain from alcohol and other chemical use, including nicotine, and to respectful, peaceful, non violent, non abusive, and non aggressive behavior during, and as a condition of, my stay at Serenity Vista. I further understand that as part of the program I will have opportunity to use a pool, spa and gym facility and participate in a variety of recreational activities as part of the program, some of which are strenuous and have inherent physical or personal risk. I acknowledge that my choice to participate in the Serenity Vista program indicates my acceptance of all risk and that I have no medical reason or advice prohibiting such use or my participation. I understand that my stay at Serenity Vista and participation in associated activities is an individual choice I freely make at the outset and accept and assume all personal responsibility for my person, health, and property. I understand that the full payment for my program is required to confirm my place in the program, and, regardless of who funded the monies, is final and non-refundable. Should I not fully complete the program, for any reason, a non-transferable credit for the unused portion of the payment may be applied toward application for a new, full program of equal duration or longer, but not less than 45 days, for me, within one year of departure, subject to policies, room availability and meeting eligibility criteria. I further understand that my continued stay at Serenity Vista is contingent upon my demonstrated compliance with the content, spirit and direction from the staff as they apply to all policies, house rules and expectations which I acknowledge I have been given opportunity to review and understand. I understand that behavior deemed by staff to be non-compliant with staff direction, policies, house rules or expectations may result in early departure from the program. I understand that my confidentiality will be strictly respected, with information regarding my stay and counselling being released only with my explicit written permission.