To Life! Therapy & Wellness

Iris Respite House Waiver

Prior to my stay at the Iris Respite House located at 183 Shafer Road, Moon Township, PA 15108 (the “Property”), I hereby acknowledge that I have read and agree to the following terms and conditions:

Open Flame Policy:

I understand the Iris Respite House is a No Open Flame facility. The use of any kind of fire is prohibited on site except in the designated smoking area. The use of any kind of fire (candles, fire pits, and smoking outside of designated area) on the Property, other than smoking in the designated smoking area, is prohibited.

Swim at Your Own Risk/Liability Release

I understand the Property has an indoor pool available for guest use. I acknowledge swimming poses inherent risks (slips, falls, drowning, serious injury, or death) and understand that the pool area is not supervised. I agree to use the pool at my own risk and release Hope Grows and its staff from any liability for accidents, injuries, or damage that may occur while using the pool facilities.  I also understand that (1) glass is not allowed in the pool area at any time, (2) consuming alcohol while swimming is prohibited; and (3) swimming while under the influence of drugs or alcohol is prohibited.

Overnight Stays

I acknowledge that an overnight manager is not on site and that I may also be the sole overnight guest on the Property. I accept full responsibility for my safety and well-being during that time.

Staff Responsibilities

I understand that staff of Hope Grows at the Property during my stay are not trained or designated as emotional support providers, counselors, or companions and cannot provide counseling/counseling-like conversations. While staff may be present on the Property their role is limited to facility operations and safety. If emotional/mental health support is desired, I understand that it can be requested upon clinical availability, but any such emotional/mental health support would be entirely separate than my overnight stay.

Clinical Support

I understand that I may request an intake call with the Hope Grows Root of Good Care Counseling team prior to my stay. Intake calls for this request are completed during regular business hours (M-F between 8 am – 4 pm). If my request falls outside normal business hours, the intake team will respond within 48-72 hours. I understand that the making, processing, and/or response to any such request is unrelated to, and entirely separate from, my overnight stay.

Release of Liability

I, on behalf of myself, anyone staying with me, and the successors, heirs, and assigns of any of us/them, hereby release waive, and discharge Hope Grows, its owners, directors, employees, agents, and representatives (collectively, “the Releasees”) from any and all liabilities, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by the Participant, or any property belonging to the Participant, while on or using the Property or its facilities.

Indemnification

The Participant agrees to indemnify and hold harmless the Releasees from any and all losses, claims, damages, or expenses, including attorneys’ fees, that may arise from the use of the Participant’s use of the Property its facilities, and/or the services received from the Participant on the Property.

I acknowledge that I have read and understood the terms of this liability release form. I voluntarily assume all risks associated with the open flame policy and swimming facilities at the Iris Respite House.