This is a general release form for services related to the Birth Spirituality and Healing Sacred Basket Program and/or Mentoring Ceremony Circles.
By signing this document, the participant agrees to release Gena McCarthy RN MFT#32708, from any liability, real or perceived, as a result of services received.
Birth Spirituality and Healing growth work can bring up strong emotions.
By signing this document the participant is stating the she feels stable and mentally and physically prepared to handle these emotions if and as they arise. Though the program is full of resourcing practices and designed to support participants to feel safe, It is also understood that the participant agrees she will seek medical, psychiatric or therapeutic help if the need arises. This help may include the services of Gena McCarthy RN, MFT#32708 and would entail a separate payment agreement than this agreement. By signing this form the participant agrees that Gena McCarthy MFT#32708 is not liable for any pain or emotional distress that may ensue in the course of this work and releases her from any arbitration.
I acknowledge that I have read this agreement, that I have executed this agreement voluntarily, and that this agreement is binding upon myself, my heirs, executors, administrators and representatives, in the even of my death or incapacity.
When you sign below, you are agreeing to the terms of this waiver.