Release of Liability form "*" indicates required fields Shadhiliyya Sufi Center, Inc. 2950 Pope Canyon Road, Pope Valley, California 94567 2950 This form must be completed by everyone visiting the Land.Legal Name* First Middle Last Date* MM slash DD slash YYYY Risks and Dangers* I hereby confirm that I understand the risks of visiting the Shadhiliyya Sufi Center and the dangers thereof and that I may be injured or harmed. I undertake to take full responsibility for my conduct and actions and warrant that I do not have a medical condition that renders me unfit to participate. I understand the center and its surrounding lands were recently burnt down in the fires and there may be hazardous materials, chemicals or debris present on site that may pose a risk to my health. I also understand that there are other dangers on the land that include but are not limited to, poisonous snakes, mountain lions, bears, other dangerous wildlife and loose hillside soil and falling rock conditions. I further understand that areas where building sites have been cleaned up after the fire are fenced off and not to be disturbed or entered until further notice.Release from Damage and Harm* I release the Shadhiliyya Sufi Center from any and all damage and/or harm, physical or psychological, that may result directly or indirectly out of my participation in visiting the center or its surrounding areas.Imdemnification of All* Furthermore, I agree to indemnify the organizers and its employees and related parties and will hold them harmless from any liability which may arise from incidents or accidents involving myself whilst on the premises, to the extent allowed by the law governing the jurisdiction in which this agreement is concluded.No Indemnification from Willful or Gross Negligence* This agreement will not serve to indemnify either party from liability arising from that party’s willful and/or gross negligent conduct.Signature*Is the person listed above a minor under the age of 18?* Yes No Minors under the age of 18 must be accompanied by an adult and require a parent/guardian's name and signature to visit the property.* First Last Parent/Guardian Signature*EmailThis field is for validation purposes and should be left unchanged. Δ