Client Consent Waiver & Release 
Lotus Flower Alchemy 

Please fill out the following client consent waiver and release in order to start booking your healing sessions. Submissions are valid up to 24 hours prior to the appointed session.

Lotus Flower Alchemy 

Kaitlin Brooks  

110 2nd Ave SW

Bowman, ND 58623 

lotusfloweralchemy@gmail.com 

 

 

 

Status and Scope of Practice

I am a certified  Auriculotherapist, Usui Reiki Master and Certified Emotion Code Practitioner. I am also a Yoga Alliance registered RYT 200, Realization Process Healing Ground Teacher, and SOMA Breath Level 1 Instructor. I am currently a student of the SOMA Breath Master Instructor training and Body Code Certifications. 

Right now, I provide all my services online via distance. All clients will be required to agree to the terms laid out below and must sign this client consent waiver & release form before receiving any sessions from any healing modality or class offered from Lotus Flower Alchemy.

  • The sole purpose for a session/s is for relaxation or stress reduction, plus also to balance, harmonize, release, and heal on all four levels (physical, mental, emotional, and spiritual).

  • The client understands that some bodily functions may temporarily be affected as a result of shifting energy within the body and agree that this is a natural occurrence

  • The client assumes sole responsibility for their own health and for the results of any sessions provided by Lotus Flower Alchemy.

  • Treatment/s and classes will not replace conventional medical diagnosis or treatment. The client will continue taking medication prescribed by a licensed medical physician and will continue to follow his/her instructions.

  • The client releases its owners and practitioners at Lotus Flower Alchemy of all legal liability during the client’s participation in treatment/s at Lotus Flower Alchemy.

  • All information received by the client from Lotus Flower Alchemy practitioners is accepted with full knowledge that any action taken by the client as a result of the information received is the client’s complete responsibility.

  • If participating in a SOMA Breathwork or yoga workshop: 

  • You agree and understand the SOMA breathwork and yoga workshops may be filmed, photographed and/or recorded and that SOMA Breath Ltd and the Teacher shall have all rights in and to such film, photographs and/or recording, including the copyright therein. The copyright shall include, but not be limited to, the right to use, re-use, publish, and re-publish and otherwise reproduce, modify, and display any such film, photograph and/or recording for educational and promotional purposes, including without limitation, audiotapes, audio CDs, DVDs, websites, video, or film or any other form of recorded images. You grant SOMA Breath Ltd and the Teacher the right, without compensation to you, to film, photograph and/or record you while participating in the Workshop/class and you waive any right which you now have or may have hereafter in any such film, photograph and/or recording. You agree to not record by audio, video, photographic or any other means, any portion of the Workshop.

  • By signing this waiver and release, the client acknowledges and agrees with the terms below and that it will be effective for all visits and across all modalities practiced:

  •   Any and all matters in dispute between the parties to this Agreement, whether arising from or relating to the Agreement itself, or arising from alleged extra-contractual facts prior to, during, or subsequent to the Agreement, including, without limitation, fraud, misrepresentation, negligence or any other alleged tort or violation of the contract, shall be governed by, construed, and enforced in accordance with the laws of the jurisdiction where the Workshop has been conducted, without regard to conflicts of law doctrines and regardless of the legal theory upon which such matter is asserted. If any portion of this Agreement is held to be invalid, it is agreed that the balance of the Agreement shall continue in full force and effect. This Agreement shall be binding upon you and your heirs, family, legal representative, successors, and assigns.

  • This Agreement constitutes the entire and final agreement between the parties and supersedes any prior oral or written agreements, discussions, or understandings. This Agreement may not be modified in any respect except in writing describing the modification and signed by both parties. By signing below, you acknowledge that you have carefully and completely read and fully understand all aspects of this Agreement and you agree to all of the terms and conditions stated herein.

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Remember to hit the back button and finish booking your appointment! 

Client Consent Waiver & Release 
Lotus Flower Alchemy 

Please fill out the following client consent waiver and release in order to start booking your healing sessions. Submissions are valid up to 24 hours prior to the appointed session.

Lotus Flower Alchemy 

Kaitlin Brooks  

110 2nd Ave SW

Bowman, ND 58623 

lotusfloweralchemy@gmail.com 

 

 

 

Status and Scope of Practice

I am a certified  Auriculotherapist, Usui Reiki Master and Certified Emotion Code Practitioner. I am also a Yoga Alliance registered RYT 200, Realization Process Healing Ground Teacher, and SOMA Breath Level 1 Instructor. I am currently a student of the SOMA Breath Master Instructor training and Body Code Certifications. 

Right now, I provide all my services of energy healings, Auriculotherapy consultations, and SOMA breathwork/yoga classes online via distance. All clients will be required to agree to the terms laid out below and must sign this client consent waiver & release form before receiving any sessions from any healing modality or class offered from Lotus Flower Alchemy.

If participating in a SOMA Breathwork or yoga workshop: 

You agree and understand the SOMA breathwork and yoga workshops may be filmed, photographed and/or recorded and that SOMA Breath Ltd and the Teacher shall have all rights in and to such film, photographs and/or recording, including the copyright therein. The copyright shall include, but not be limited to, the right to use, re-use, publish, and re-publish and otherwise reproduce, modify, and display any such film, photograph and/or recording for educational and promotional purposes, including without limitation, audiotapes, audio CDs, DVDs, websites, video, or film or any other form of recorded images. You grant SOMA Breath Ltd and the Teacher the right, without compensation to you, to film, photograph and/or record you while participating in the Workshop/class and you waive any right which you now have or may have hereafter in any such film, photograph and/or recording. You agree to not record by audio, video, photographic or any other means, any portion of the Workshop.

By signing this waiver and release, the client acknowledges and agrees with the terms below and that it will be effective for all visits and across all modalities practiced:

  Any and all matters in dispute between the parties to this Agreement, whether arising from or relating to the Agreement itself, or arising from alleged extra-contractual facts prior to, during, or subsequent to the Agreement, including, without limitation, fraud, misrepresentation, negligence or any other alleged tort or violation of the contract, shall be governed by, construed, and enforced in accordance with the laws of the jurisdiction where the Workshop has been conducted, without regard to conflicts of law doctrines and regardless of the legal theory upon which such matter is asserted. If any portion of this Agreement is held to be invalid, it is agreed that the balance of the Agreement shall continue in full force and effect. This Agreement shall be binding upon you and your heirs, family, legal representative, successors, and assigns.

This Agreement constitutes the entire and final agreement between the parties and supersedes any prior oral or written agreements, discussions, or understandings. This Agreement may not be modified in any respect except in writing describing the modification and signed by both parties. By signing below, you acknowledge that you have carefully and completely read and fully understand all aspects of this Agreement and you agree to all of the terms and conditions stated herein.

Upload File

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Remember to hit the back button to finish booking your appointment!