Client Acknowledgement & Liability Release Form
OverSoulVibration.com
Name
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First Name
Last Name
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Email
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example@example.com
Session Information
Date of Session with Daisy May
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Date
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Online
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Responsibility and Liability Release
I voluntarily agree to sign this agreement and assumption of risks, because I fully understand that Daisy May M. Reyes, D.B.A., OverSoul Vibration™, who is going to facilitate hypnosis as a practitioner, is not a doctor, nor has a degree in psychiatry, and can neither diagnose nor treat any type of physical or mental disorder.
Disclaimer
Hypnosis and Energy Healing are not intended to cure any specific condition. Daisy May M. Reyes, D.B.A., OverSoul Vibration™, make absolutely no claims of a cure for any disease. Individual results may vary. Each session is unique, and its success depends on your cooperation and faith in the process.
I acknowledge the following:
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I agree to the statements above.
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I further acknowledge the following:
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I agree to the statements above.
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Session Video Permission For Educational Purposes
Does Daisy May have your permission to share your *anonymous* information on YouTube?
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Yes
No
Does Daisy May have your permission to share your *edited* video session on YouTube if you have watched it first and are happy with the content?
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Yes
No
I understand that If I answered "YES" to share my information anonymously, that Daisy May will share my anonymized information on her YouTube channel.
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I understand that If I answered "YES" to share my edited video, that Daisy May will post the edited video on her YouTube channel.
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I also understand that by agreeing to share my *edited* session video, this is my opportunity to promote either myself as a brand, my business, and/or products on Daisy May's YouTube channel.
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I also understand that if I answered "NO" to sharing my anonymized information and "NO" to sharing my edited video, that Daisy May will *not* share any of my information.
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Agreement
I agree and I accept that I am a willing participant in this cooperative relationship that will employ hypnotic techniques, regression, NLP, energy healing, and any other appropriate modality by Daisy May M. Reyes, D.B.A., OverSoul Vibration™, therefore, I do hereby release and discharge Daisy May M. Reyes, D.B.A., OverSoul Vibration™, from all claims of damages, copyright, demands or actions whatsoever in any manner arising from or growing out of my cooperative participation. I have received and read this Patron Information & Agreement Form and understand what l have read.
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I confirm that all the above information given is correct.
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