Welcome to Dancing Hearts - Holistic Learning Center


	2004 ILLINOIS VETERINARY ACT STATEMENT OF DISCLOSURE Agreement and Acknowledgement
	In compliance with the Illinois Veterinary Medicine and Surgery Practice Act of 2004 the following information is being provided to you as the legal "owner or agent of the owner" of your companion animals. Kathy Kawalec is not a veterinarian; does not diagnose medical issues, offer medical advice, prescribe drugs, or perform surgery. The services and products provided by Kathy Kawalec and Dancing Hearts are not a substitute for, but are meant to complement good veterinary care, proper nutrition, exercise and training. My agreement acknowledges that I have read the above disclosure statement pertaining to the services and products provided. This Agreement and Acknowledgement is set forth in compliance with the Illinois Veterinary Medicine and Surgery Act of 2004.
	CLIENT AGREEMENT
	I hereby agree to the services provided by Kathy Kawalec and Dancing Hearts as set forth by my agreement below. I understand that these services and related products are not a substitute for medical or veterinary care and advice. I understand that there are no guarantees, express or implied, of changing the behavior or well-being or myself or my animal(s). I further agree to indemnify, release and hold harmless Kathy Kawalec, Dancing Hearts and any related entity from any and all claims, actions, and judgments arising from and related to the services and products provided. In the event any claim or suit is brought against Kathy Kawalec, Dancing Hearts or any related entity within the scope of this Agreement, I agree to pay for legal counsel chosen by Kathy Kawalec or her agent to defend against the same. In the event the actions of my animal or myself cause damage to any person or property, including the livestock, at Dancing Hearts, I agree to pay for all damages and/or replacement cost as determined by Kathy Kawalec or her agent. I also acknowledge that the audio and/or visual portions of any class or other onsite or remote event may be recorded and/or transcribed and then distributed for sale or otherwise and/or used in promotional materials. In consideration for access to the class or other event, I hereby waive and relinquish any and all claims for remuneration and any rights to object to release of any such recordings or transcripts, including images, recordings, or transcriptions.
	Signed by: (Owner or Owner Agent)
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	I have read the Statement of Disclosure and Client Agreement and by submitting this form, I agree to abide by the terms of that agreement.

2004 ILLINOIS VETERINARY ACT STATEMENT OF DISCLOSURE

Agreement and Acknowledgement

CLIENT AGREEMENT