Golden Aura Holistic Wellness Release Form

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Today's Date:

Fri Mar 24 2023 12:17

Practitioner:*

Please read and answer

Terms & Conditions

You must agree to these terms and conditions to attend Golden Aura holistic appointments or classes. Please read carefully, as our policies have been recently updated.

I agree that Golden Aura Inc. is in no way responsible for the safekeeping of my personal belongings while I attend class or appointments.

I understand that practices and classes may be physically strenuous and I voluntarily participate in them with full knowledge that there is risk of personal injury, property loss or death.

I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against Golden Aura Inc. or its members for any personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise.

Please check the box to indicate you have read and agree to the terms and conditions outlined in this section.

Holistic Health Disclaimer*

The use of yoga, meditation, Reiki/energy healing, shamanic healing, crystal healing, as well as sound bathing/healing are considered alternative, complementary approaches and do not replace the need for traditional medical care through your physician or licensed professional.

You should not stop, add, or change any medication or traditional treatment, without the advice, consent and direction of your physician. You are advised to seek the care of a licensed professional for any physical, mental or emotional concerns.

Although yoga and mindfulness have been scientifically tested and proven to offer numerous health-related benefits, Golden Aura and it’s representatives are NOT medical professionals or therapists. We are advocates and teachers of wellbeing & wellness practices.

Services and information are NOT intended to diagnose, treat, or cure. Please consult a medical professional or mental health care provider if you or someone you know are seeking medical advice, diagnosis or treatment.

The choices you make and the actions you take are solely your responsibility. You agree to completely hold harmless and absolutely indemnify Golden Aura Inc. and any persons associated with Golden Aura Inc., from any and all liabilities and expenses.

I acknowledge that long term imbalances in the body or mind sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body or mind to heal itself.

Please check the box to indicate you have read and agree to the terms and conditions outlined in this section.

Consent to Touch *

Healthy, appropriate touch has been proven to be a very beneficial method for promoting relaxation and healing (examples include massage, reiki, and reflexology).

Our trained practitioner will always ask you to confirm consent before beginning any service involving touch. (Breast, buttocks, and genitals will NEVER be touched during any service provided.)

Some individuals prefer no touch because of sensitivity related to past trauma/abuse, medical condition, or injury. Services can be modified to use a hands-off approach, if preferred.

Verbal permission prior to start of service is required, and necessary on behalf of both parties, service provider and recipient. Consent may be given or rescinded at any time, by either party, before and during services.

Please check the box to indicate you have read and agree to the terms and conditions outlined in this section.

Release of Liability*

I also hold Golden Aura, it's practitioners, employees, owners, and representatives harmless from all liability to any other person or entity arising as a result of the conduct of myself for the other participants in the service or activity. I agree to defend and indemnify Golden Aura, it's practitioners, employees, owners, and representatives against any claim or liability arising as a result of such conduct.

If I’m not able to be consulted for any reason in the case of an emergency or necessity arising during the course of the activity or service, or as a result of the activity, I authorize you to contact the emergency contact person or persons listed below and to arrange for such medical and hospital treatment as you may deem to be advisable for my health and well-being.

Please check the box to indicate you have read and agree to the terms and conditions outlined in this section.

Religious Disclaimer

We respect all individuals and their right to believe what they choose. We do not promote any specific religious ideology, although we may share information from many different cultures and religious backgrounds.

We do NOT provide religious advice, nor will we ever promote conversion to any particular religion or belief or set of beliefs. We simply offer our own experiences and willingness to explore with other seekers along this journey we call LIFE.

We will never require any participant to identify their religious or personal beliefs. Participants DO NOT have to be religious or even be interested in religion.

Our classes are taught with an emphasis on following your own heart and mind to discover what may be true for you. We allow space for everyone’s personal truth and we encourage each to remain in their own truth without judgement of self or others.

YOGA IS NOT A RELIGION. Yoga can help us learn to move and breathe easier with life, no matter what we believe. We will encourage you to trust your journey, your own interpretation of divinity, and expect that this too may evolve and be ever-changing.

REIKI IS NOT A RELIGION. Reiki is a Japanese technique that uses gentle touch to promote natural healing responses within body. It is also useful for developing awareness of the intelligence of the heart, mind, body connections. Reiki can be a tool for reintroducing healthy touch to survivors of sexual trauma, domestic violence or abuse. We offer private Reiki appointments for individuals wanting to learn more or experience Reiki administered by a certified Reiki Master/Teacher. In addition, we offer training workshops for those who wish to learn to administer Reiki to themselves and others. We welcome non-offending loved ones to participate. We have the right to refuse training or services to anyone for any reason.

Please check the box to indicate you have read and agree to the terms and conditions outlined in this section.

Cancellations, Rescheduling, Refund Policies

If you are unable to attend your appointment for any reason, please notify us as soon as possible.

Your payment is a retainer for the time you are requesting and is non-refundable.

If an appointment/class is missed, WITH prior notice, you may request a new appointment, no additional payment required, no refunds.

If an appointment/class is missed, WITHOUT prior notice - forfeiture of full payment, new payment for rescheduling required.

2+ missed appointments/classes without prior notice will result in termination of client/provider relationship, future scheduling requests will be denied.

Please check the box to indicate you have read and agree to the terms and conditions outlined in this section.

Late Arrivals

PRIVATE APPOINTMENT POLICY
If you are running late for a private session reservation, we will allow a 10 minute grace period for you to arrive. We will NOT extend the session beyond original reservation timeframe to accommodate late arrival. Please arrive on time and prepared for your appointment, aiming to make the most of our time together.

GROUP CLASS POLICY
The exterior doors will lock at the time group classes/workshops are scheduled to start. If participant is not inside the studio doors prior to the start time of the class, they will be marked as a no show for the reservation. By checking the box, you agree you do not expect the class to start on your schedule or the doors to be held open or left unlocked for you if running late to class.

Please check the box to indicate you have read and agree to the terms and conditions outlined in this section.

Medical Information*

Are you currently under the care of a physician or any other health care professional? If so, please provide details- physician name, location, diagnosis or condition being treated.

Details:

Allergies*

Do you have any allergies? If so, please list.

Details:

Sensitivity*

Are you sensitive to perfumes or fragrances? If so, please list.

Details:

Goals & Desired Outcomes*

What are you hoping to learn or achieve?

Areas of Interest*

Sessions may include a combination of practices designed to meet your needs and preferences. Please list any practices you would like to try and are open to exploring. Examples may include but are not limited to yoga, meditation, reiki, sound healing, intuitive movement/dance.

Reservation Date/Time Request*

What dates and times will work best for you? Please list at least 3 preferred dates and times that you are available for your session. (Sessions are approximately 90 minutes.)

Payment Required to Retain Reservation*

VERY IMPORTANT: PLEASE READ CAREFULLY. CHECK THE BOX TO INDICATE YOU HAVE READ & UNDERSTAND.

You will receive 3 emails after completing this electronic request form.

1st email - a copy of this document for your records, with your completed responses

2nd email - from GoldenAuraGoddess@gmail.com will contain your appointment reservation date/time and information on how to prepare for your appointment

3rd email - Square invoice/payment request for the full fee for your session, due upon receipt to secure your appointment reservation

***Please pay the online invoice as soon as possible. Your payment is your retainer for your appointment and is required to complete your reservation. Appointments are only confirmed after full payment is received.***

We accept credit/debit/gift cards and offer secured electronic payment processing through Square online invoicing. We do NOT currently accept Paypal, Venmo, or any other forms of e-payment.

Privacy Notice: No information about any client will be discussed or shared with any third party without written consent of the client (or parent/guardian if the client is under 18).

If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

Personal Info

I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.

Legal Name:*

Pronoun:

Chosen name:

Address:*

Postcode:*

Date of birth:*

If you are under 18 your parent/guardian will be required

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Emergency Contact

If something happens, your emergency contact might need to explain your medical history, allergies, or medications.

Name:

Phone #:*