ANXIETY RESOURCE CENTER, INC.
PARTICIPANT RELEASE AND WAIVER

This Release and Waiver of liability is executed this date:

(the “participant”) in favor of the Anxiety Resource Center, Inc. and its directors, officers, volunteers, employees, and agents (“ARC”).

I acknowledge that I am or wish to be a participant in one or more groups, presentations or programs at ARC. I am not an employee, agent, or independent contractor of ARC and I am not a patient or client of ARC. I understand and acknowledge that in fulfilling its mission and purpose, ARC provides a setting for persons with various forms of anxiety and anxiety disorders, as well as their family and friends, to come together in mutual support and education. I understand and acknowledge that ARC does not screen or evaluate persons who wish to participate in programs it offers or groups that it organizes. I also understand that ARC does not provide or sponsor, or hold itself out as providing, professional therapy or treatment to participants in or through its program offerings; and that ARC does not endorse, recommend or represent any physician, counselor, therapist or other professional who presents to or leads any group or educational event at the ARC or endorse or recommend any particular form of treatment or therapy presented or discussed in a program or group. With these acknowledgements, and as a condition of being a participant in programs and groups offered or coordinated through ARC, I am freely and voluntarily delivering this Release and Waiver Agreement under the following terms:

Waiver and Release: I hereby release and forever discharge and hold harmless ARC and its successors and assigns from any and all liability, claims, demands and causes of action arising from or relating to my participation in each and any program or group sponsored, coordinated or presented by or at ARC. Without limiting the breadth or scope of the foregoing release, I specifically understand and acknowledge that this Release discharges ARC from liability or claims that I may have with respect to personal injury (including mental distress), illness, death, or property damage. I further understand that ARC does not claim to, or assume any responsibility or obligation to, provide psychological, psychiatric, medical, counseling, therapy or other professional care to me through any program or group offering. I expressly waive and release any claim against ARC based upon advice, education, training or subsequent care I receive from any such physician, counselor, therapist, facilitator or other professional, as well as any claim based upon misconduct or professional negligence of such persons. I further understand and agree that some groups and mutual support activities at ARC are led by volunteers who may not be specially trained and are not employees or agents of ARC while others are led by independent facilitators who may or may not receive payment for their work. I understand and acknowledge that their actions and activities are not directed or controlled by ARC and I therefore waive, release and hold harmless ARC from any liability or claim arising from the conduct of such volunteers and facilitators in any capacity.

Medical Treatment: I hereby release and discharge ARC and its successors and assigns from any and all liability claims, demands, and causes of action on account of first aid or other medical treatment rendered during my participation in any group or program sponsored or coordinated by or held at ARC.

Other: I expressly understand and agree that this Release and Waiver is intended to be as broad and inclusive as permitted by law, and that this Release and Waiver shall be governed by and interpreted in accordance with the laws of the State of Michigan. I agree that in the event that any clause or provision of this Release and Waiver is determined to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not affect the remaining provisions of this Release.