Clients Declaration and Consent Form
for all services at The Wellbeing Sanctuary for balanced life training.
I hereby declare that it is I who have chosen to avail the services of the Wellbeing Sanctuary and I give my full consent to receiving and participating in any Private Consultations, Training Sessions, Workshops, Classes, and
other services in Well Being Therapies at The Wellbeing Sanctuary, online or in other venues as organized by them. I
fully understand that the results of these activities may vary and that the assigned practitioner, facilitator, or trainer may not guarantee results.
I acknowledge that the Private Consultations, Workshops, Classes, and other services offered by The Wellbeing Sanctuary are not a replacement for medical treatment, psychological or psychiatric services, or counseling. I also understand that the practitioners, trainers, facilitators, or any member associated with The Wellbeing Sanctuary do not treat, prescribe for, or diagnose any condition.
I am fully aware and understand that in some cases it may be necessary for the practitioner to respectfully touch my shoulder(s), hands, wrist, or forehead in order to assist me in relaxation. I give the practitioner permission and consent to do so in order to help me establish an appropriate receptive state.
I have been advised that I am free to terminate any or all sessions at any time in agreement with the appointment cancellation policy in accordance with The Wellbeing Sanctuary’s terms and conditions regarding payments. I have agreed to progressively participate in each session to the best of my ability. I have accurately provided background information regarding my case as requested by the practitioner. I understand that confidentiality regarding my sessions will be confidential and honored between my therapist/practitioner, and myself.
Liability Waiver and Release
I agree to assume all of the risks and responsibilities in any way associated with the activities undertaken. In consideration of and return for the services, facilities, and other assistance provided to me by The Wellbeing Sanctuary.
I Release, indemnify and hold harmless The Wellbeing Sanctuary, its employees, practitioners, facilitators, trainers, community partner organizations and agents, from any liability, claims, and actions that may arise from injury or harm to me, or from damage to my property in connection with these activities.
I understand that this Waiver and Release covers liability, claims and actions caused entirely or in part by any acts, or failure to act of The Wellbeing Sanctuary for balanced life training, its employees, practitioners, facilitators, trainers, community partner organizations and agents, including but not limited to negligence, mistake, or failure to supervise.
I recognize that this Release means I am giving up, amongst other things, rights to sue The Wellbeing Sanctuary for balanced life training, its employees, practitioners, facilitators, trainers, community partner organizations, and agents for any injuries, harm, damages, or losses I may incur. I also understand that this Release binds my heirs, executors, administrators, and assigns, as well as myself.
The Wellbeing Sanctuary has the right to have any participant activity terminated and removed from the organizing venue if the participant poses any threat to themselves or others or exhibits unacceptable behavior.
I have read this release, I fully understand it and I fully agree to be legally bound by it.
Upon signing this form, I am in full agreement with all of The Wellbeing Sanctuary’s Policies including terms and conditions, agree to the Consent Form and Liability Waiver and Release. I agree that I have provided all accurate information to the best of my knowledge. I give The Wellbeing Sanctuary consent to use my details to inform me of any special offers, events, and appointment confirmations via email or phone. (These details will remain private!)