Liability Waiver and Release Form
Assumption of Risk: In consideration of being permitted to participate in a session, I agree to assume full responsibility for any risks, injuries, or damages, known or unknown, which I might incur as a result of participating in any such in person or distance B.E.S.T., Spiritual B.E.S.T. Healing Touch, micro retreat and/or intuitive reading session. Healing Touch, Reiki, NLP, Theta Healing Energy Codes Life Coach, Energy Codes Facilitation, flower essences, essential oils, shamanism, breath work, yoga, intuitive readings, energetic house cleansing and sound healing.
Waiver: In further consideration of being permitted to participate in B.E.S.T., Healing Touch, Coaching, and/or intuitive reading session, etc. I knowingly, voluntarily and expressly waive, release and discharge, any claim that I, for myself, my heirs, personal representatives, or assigns may have against Aline Love, HTP and/or Everything Always Works Out, or their respective officers, managers, directors, members, employees and agents for injury or damages that I may sustain as a result of participating in a B.E.S.T., Spiritual B.E.S.T., Healing Touch, micro retreat, or intuitive reading session. Healing Touch, Reiki, NLP, Theta Healing, Energy Codes Coaching, Energy Codes Facilitation, flower essences, essential oils, shamanism, breath work, yoga, tarot readings, energetic house cleansing and sound healing.
Indemnification and Hold Harmless: I agree to hold harmless and indemnify Aline Love, HTP and/or Everything Always Works Out from all claims, actions, suits, procedures, costs, expenses, damages and liability, including attorney’s fees incurred, and to reimburse them for any such or further expense incurred Aline Love, HTP and/or Everything Always Works Out in investigating and defending a claim or suit brought by me, my heirs, personal representatives or assigns.
Severability: Finally, I agree that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the laws of the state of Arkansas and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
About Aline Love, HTP & SCOPE OF PRACTICE
Aline Love practices Healing Touch, Reiki, NLP, Theta Healing,B.E.S.T., Energy Codes Facilitation, flower essences, essential oils, shamanism, breath work, tarot readings, energetic house cleansing and sound healing. Aline Love is an intuitive local and distance healing practitioner and practices various forms of intuitive energy healing. Energy healing is a gentle energy-based approach to health and healing that can assist in the body’s ability to self-heal.
Description of a Session
Sessions are provided in-person and over distance by Zoom, What’s App, phone or by e-mail. For all of my sessions, I come to the session grounded and centered. I am fully present to listen to you and work with you in a heart-centered manner and I leave all of my personal information and details at the door. During an in-person session, I will gently place my hands on or above a client’s fully clothed body and notice any irregularities or imbalances in the energy field. I then will use the following modalities so support the re-balancing of the energy system. During a distance session, I use my intuition to notice any irregularities or imbalances in the energy field. I then use distance healing intention modalities such as visualization, imagery, or intention to support the re-balancing of the energy system. Many healing traditions stress that the balancing of the energy field can support the body, mind, and spirit in moving towards or maintaining wellness.
Acknowledgement, Consent, Client Rights
I have read and understand the disclosure regarding the services offered by Aline Love. This is an agreement between the client and Aline Love (the practitioner) concerning the Energy Healing Session(s) and upon submitting this agreement the client agrees to all terms laid out in this agreement.
By completing the form below, I also indicate that I have read, understand and agree to the following statements:
I authorize and request my practitioner to carry out Energy Healing sessions.
I also understand that while the course of my session is designed to be helpful, Aline Love can make no guarantees about the outcome of my session. Further, this process can bring up uncomfortable feelings and reactions such as anxiety, sadness and anger. I understand that this is a normal response to working through unresolved life experiences and that these reactions will be worked on between my practitioner and me.
I am at least 18 years old, the age of consent to make any decisions as to my person and treatment.
I understand that if my session is done in-person the practitioner may lay her hands lightly on my body, particularly on head and over the heart and stomach. However, this will be done only with my consent. I will remain fully clothed during my session.
I understand that Aline Love provides healing intention therapies over distance. These therapies include energy healing, intuitive healing, prayer, Spiritual healing, shamanic healing, Healing Touch, Quantum Touch, etc
I understand that receiving a healing session will not interfere or replace traditional medical or psychiatric care but can enhance other medical/psychiatric treatments. Therefore, clients under current medical or psychiatric care should not stop treatments or medication without advice of their physician/psychiatrist.
I understand that Aline Love does not diagnose or treat disease and is not a licensed physician or mental health practitioner.
I understand that these sessions are not a substitute for diagnosis or treatment from a qualified or licensed health practitioner for illnesses, injuries, or other medical conditions.
I understand that communication via email or cell phone may not be secure and take responsibility when using these communication channels to provide information.
I give permission for YOUR NAME to leave or send me a message at the phone numbers and email addresses that I provide.
I understand that all information between practitioner and client is held strictly confidential. There are legal exceptions to this: a) The client is under criminal investigation and a subpoena by a court of law has been issued for information on the client. b) Abuse and/or neglect are suspected. c) The client presents as a physical danger to self or others. d) The client authorizes a release of information with a signature. In the case of #b or #c above, we are required by law to inform potential victims and legal authorities so that protective measures can be taken.
I understand that I am responsible for payment of all fees charged at the time of service to be paid either prior to or on the day of service. I agree to pay for all services rendered.
I am expected to arrive on time on agreed upon appointment date and time. If I am 15 minutes or more tardy, then I will be charged for this time accordingly. Cancellations must be made at least 48 hours prior to appointment; otherwise, I will be responsible for full cost of session. Should there be an emergency, no charge will be made, however, proof of said emergency will be required to void payment requirement.
I understand that Aline Love reserves the right to refuse any session without providing a reason and can cancel said session at any time. Any payment made prior to a session that is canceled by the practitioner will be refunded in full.
I understand that my relationship with my practitioner is entirely professional and so any behavior on my part that is not professional and can be deemed sexual or abusive will be reported to the authorities.
By submitting below, I certify that I have read and understand this agreement and have full knowledge of its meaning and effect. If I violate the agreement, I know that the practitioner may discontinue sessions.