Birth From the Inside Out Workshop Registration Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *Workshop Location *Las Vegas, NV (April 9-11, 2026) - Anchor Chiropractic 4175 S Riley St, Unit 105 Las Vegas, NV 89147Overland Park, KS (April 17-19, 2026) - Sacred Song Homebirth 4831 Antioch Road Overland Park, KS 66203Riverside, CA (April 23-25, 2026) - 451 Two Trees Road Riverside, CA 92507How did you hear about this workshop?Select Payment Option *One time payment ($800.00)Installment payments ($266.66 x 3 months)*Cancellations will be refunded, less a $50 admin fee that will be subtracted from the refund.Coupon Apply Release of Liability *By signing this form, I (listed as the “Participant”), execute this Waiver and Release (the “Waiver and Release”) in connection with my participation in the Birth from the Inside Out Workshop (the “Workshop”) described below.The Workshop is offered by Restorative Birthwork. I voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including, but not limited to, suffering and/or death, whether foreseen or unforeseen, that may be sustained by me, or any loss or damage to property owned by me, as a result of my participation in the Workshop, and all related activities incident thereto. “Related activities” means any and all matters and activities related directly or indirectly to the Workshop, including giving and receiving touch and bodywork, working with massage tables, and various practitioner and recipient positions. I recognize that there are potential risks of injury, damage or harm inherent in my participation in the Workshop, and that it is not possible to specifically list each and every individual risk. These risks may include: (a) risks inherent in discussing and exploring birth; (b) risks and dangers caused by the negligence or willful acts of the owners, employees, officers or agents of the Workshop facility, or any guides who are not affiliated with Restorative Birthwork or by other participants in the Workshop; and (c) cancellation or interruption due to natural dangers, such as tornadoes, earthquakes, or other natural disasters. I hereby expressly assume any and all risks (including but not limited to the foregoing risks) in attending and participating in the Workshop. In exchange for the opportunity to participate in and attend the Workshop, I hereby release, waive, discharge and covenant not to sue Restorative Birthwork, its instructors, and any person or entity listed under my signature below, and their officers and current or former employees or agents (hereinafter referred to as “Released Parties”) from any and all liability, claims, demands, actions and damage, or injury, including death, that may be sustained by me, while participating in the Workshop. I further hereby agree to indemnify and hold harmless the Released Parties from any loss, liability, damage or cost, including costs and attorney’s fees that may be incurred due to my participation in the Workshop, whether caused by the negligence of any of the Released Parties or otherwise. It is my express intent that this Waiver and Release shall bind the members of my family, if I am alive, and my heirs, assigns and personal representative, if I am deceased, as shall be deemed as a release, waiver, discharge and covenant not to sue the above-named Released Parties. I have had an opportunity to ask questions and obtain information regarding the Workshop to my satisfaction. I subjectively understand the risks of my participation in the Workshop and knowing and appreciating these risks, I voluntarily choose to participate, assuming all risks due to my participation. I warrant to the Released Parties that I have no physical, emotional, or psychological condition which would keep me from participating in and enjoying the benefits of the Workshop or which would cause me injuries or harm. WITHOUT LIMITING THE FOREGOING, THE RELEASED PARTIES SHALL NOT BE LIABLE FOR ANY INDIRECT, INCIDENTAL, CONSEQUENTIAL OR PUNITIVE DAMAGES, WHETHER BASED IN CONTRACT, TORT OR ANY OTHER THEORY ARISING FROM OR RELATING TO ANY INJURIES SUFFERED WHILE AT THE WORKSHOP. THE RELEASED PARTIES WILL NOT BE LIABLE TO THE PARTICIPANT OR HIS OR HER HEIRS OR BENEFICIARIES FOR ANY AMOUNT IN EXCESS OF THE TOTAL FEES PAID BY PARTICIPANT FOR THE WORKSHOP. I intend that if any term or provision of this Waiver and Release shall be held illegal, unenforceable, or in conflict with any law, the validity of the remaining portions shall not be affected thereby. I AM OVER 18 YEARS OF AGE, HAVE READ THIS WAIVER AND RELEASE AND BY SIGNING IT AGREE TO ITS TERMS. IT IS MY INTENTION TO WAIVE AND RELEASE THE RELEASED PARTIES FROM THE CLAIMS HEREIN RELEASE. I ACKNOWLEDGE THAT THIS RELEASE EXTENDS TO PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE. Instructors and additional Released Parties: Restorative Birthwork Instructors/Assistants, Jamie Mossay, Nicole Morales, Emma Moreland, and Rindi Cullen-MartinMedia Release *By signing this form, I (listed as the “Participant”), execute this Waiver and Release (the “Waiver and Release”) in connection with media obtained during my participation in the Birth from the Inside Out Workshop (the “Workshop”) described below.I hereby grant Restorative Birthwork the absolute and irrevocable right and permission, in respect of the photographs, audio, and/or video taken of me alone or with others, to use, re-use, publish, and re-publish the same in whole or in part, individually or in conjunction with other photographs or video, and in conjunction with any printed matter, or electronic matter, in any and all media now or hereafter known, and for any purpose whatsoever; and to use my name in conjunction therewith if Restorative Birthwork so chooses. I hereby release and discharge Restorative Birthwork from any and all claims and demands arising out of or in connection with the use of the photographs or video, including without limitation any and all claims for libel or invasion of privacy. This authorization and release shall also inure to the benefit of the heirs, legal representatives, licensees, and assigns of Restorative Birthwork. I am of full age (18) and have the right to contract in my own name. I have read the foregoing and fully understand the contents thereof. The release shall be binding upon me and my heirs, legal representatives, and assigns. I understand that I can, at any time, withdraw, or modify consent, by contacting workshops@restorybirthwork.com. Instructors and additional Released Parties: Restorative Birthwork Instructors/Assistants, Jamie Mossay, Nicole Morales, Emma Moreland, and Rindi Cullen-Martin.Comments or questions?Submit