Insight For Life Registration
Program Selection
Parent Information
Hold Harmless Agreement
Hold Harmless, Disclaimer, Release and Arbitration Agreement
Training: CIJ Insight For Life For Kids and Teens
Print Student Name: ___________________________________________ Print Parent Name:_____________________________________________ Please read this Agreement carefully; it is a binding legal contract between Kourtney Lynn, LLC and you, the legal parent or guardian of the student who is
under 18. Your signature below indicates that you are in complete agreement with all terms set forth below. Initial each and every provision in the space provided to indicate that you have read and fully understand each provision listed.​
I am fully informed to my satisfaction about the program provided by Kourtney Lynn, LLC and willingly and voluntarily choose to participate in the workshop at this time.
I understand that the CIJ Insight For Life training is an experiential, philosophical, educational program that may or may not assist in personal growth. It is not intended to be psychotherapy or medical therapy or a substitute for either one. Kourtney Lynn, LLC is not a psychiatrist or psychologist.
I do not have any doubts about my child’s mental health, emotional stability or physical ability to handle this program. Any doubts I may have had were resolved by me before I decided to enroll by consulting a physician, psychiatrist, psychotherapist or psychologist knowledgeable about the program, who has no objections to my child’s participations in the program.
I understand that Kourtney Lynn, LLC is responsible only for presenting the program in an orderly manner. Kourtney Lynn, LLC is not my fiduciary and I do not expect this program to be administered with the standard of care expected of trained mental health professionals. If my child feels mental or physical discomfort or adverse effects during the program, I promise to inform the trainer. I understand I am free to have my child leave the program at any time for any reason.
If my child has had serious emotional or mental health difficulties, has been hospitalized for emotional or mental health problems or is currently under the care of a therapist, I understand that it is recommended that they attend the training ONLY with written consent of their therapist, psychologist, psychiatrist or other physician
I understand that Kourtney Lynn, LLC is responsible only for presenting the program in an orderly manner. Kourtney Lynn, LLC is not my fiduciary and I do not expect this program to be administered with the standard of care expected of trained mental health professionals. If my child feels mental or physical discomfort or adverse effects during the program, I promise to inform the trainer. I understand I am free to have my child leave the program at any time for any reason.