Name
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First Name
Last Name
Email
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Date of Birth
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Phone Number
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Do you have any physical limitations?
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What is the main challenge you would like to work on?
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How would you like to feel once you're finished with the program?
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Is there anything else you would like me to know?
Agreement of Release and Waiver of Liability
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It is your responsibility to inform the instructor of limitations before class begins. Please read the following and ask if you have any questions.
I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I assume full responsibility for any and all damages, which may incur through participation. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program. In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against High Vibrations Energy Healing, its owners, officers, employees, and instructors.
I understand that Reiki is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation. I understand that Reiki practitioners do not diagnose conditions nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that Reiki does not take the place of medical care. It is recommended that I see a licensed physician or licensed healthcare professional for any physical or psychological ailment I may have. I understand that Reiki can complement any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so complete relaxation is often beneficial. I acknowledge that long-term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself.
I have read and fully understand and agree to the above terms of this Agreement and Release of Waiver of Liability. I am signing this agreement voluntarily and recognize that my signature serves as complete and unconditional release of all liability to the greatest extent allowed by law in the State of Florida.
Program Completion Policy
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By enrolling in this program, you agree to begin and complete all sessions within 6 months of your sign-up date, unless otherwise agreed to in writing.
This timeframe protects the momentum, energetic integrity, and transformational arc of the container.
Please note:
Unused sessions will expire after 6 months.
It’s your responsibility to schedule sessions within this timeframe.
If something major comes up, I’m always open to discussing an aligned path forward — just reach out early so we can adjust with care.
Thank you for honouring this container and showing up for your growth with intention.
