Group Gong Bath Consent Form

Booking Form - Group Gong Bath

Consent, Registration Form for a private group gong bath with Claire Empson
Your Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Guest 2

First NameLast Name
Guest 3

First NameLast Name
Guest 4

First NameLast Name
Guest 5

First NameLast Name
Consent:

I consent to receive a Sound Journey including Gongs from Claire Empson. I understand that 'Sound Healing' is a complementary therapy and is not a substitute for medical or psychiatric treatment. I release Claire from any liability or responsibility from any percieved outcomes or lack thereof
Signature*

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Date of Signing*

MonthDayYear
Date
1. Have you and your guests experienced a gong bath/sound journey before?

YesNoSome have and some haven't
Please describe briefly what your collective experience has been/ how many have not had a gong bath experience before
2. Does anyone have any medical conditions or physical limitations/adjustments needed that Claire should be aware of?*

YesNo
If yes, please specify:
4. Are any of your party pregnant?*

YesNo
If yes, please specify which trimester/how many weeks:
Pregnant individuals, especially those in their first trimester, should avoid Gong Baths due to the intense sound vibrations that may disrupt the delicate stages of early pregnancy. As a precaution, expectant mothers should consult their healthcare provider before considering participation in a Gong Bath during any stage of pregnancy.

By booking and attending you are accepting responsibility for having informed your guests of this information.

See below link for further contraindications for Gong/Sound Baths

Contraindications information
Please click yes to indicate you have read the contraindications on the link above, you have passed on the link for your guests to read too, and you accept full responsibility for the individuals in your booking.*

Yes
6. Is there anything else you would like Claire to know before the session about you or guests' physical, emotional or mental state, or something else?
Declaration:

I declare that the information provided above is accurate and complete to the best of my knowledge. I understand that it is my responsibility to inform the practitioner of any changes to my health status, or thoe of my guests, or circumstances that may affect the outcome of the Sound Journey
Signature*

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Date of Signing*

MonthDayYear
Date
Thank you for completing this form. If you have any questions or concerns, please feel free to discuss them with me before the session begins.
Privacy Statement
Have you paid?*

Yes, I have already paidNo, I need to pay
My Experiences:*
prevnext( X )
Private Group Sound JourneyIn Person 45 mins (1 hour appointment) in my Sanctuary
£95.00 Quantity



Private Group Sound Journey - bespoke experienceIn Person 45 mins gong + tea /cards /sharing circle (2 hour session) in my Sanctuary
£150.00 Quantity



Bespoke private event session, your alternative venue, costs TBDClick 'I have already paid' and Contact me for payment link
£ Free Quantity



Total

£0.00
Which experience have you purchased?

Private Group Sound Journey £95Private Group Sound Journey - bespoke experience £150Bespoke private event session, your alternative venue, costs TBA
Do you consent to be added to my mailing list?*

YesNo

Payment Methods

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Choose from one of the PayPal options to make your payment.

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Booking Form - Group Gong Bath