Sound Healing Registration Form

Sound Healing Registration Form & Waiver

Divine Rebels Bi-Monthly Sound Healing Circle
Join us for a bi-monthly Divine Rebel Sound Healing Circles. I'm very excited to bring these circles back. This is not just a sound bath, its a full concert experience where you will be transported by sound, meditation and the energey of a safe community.

We start with meditations, set and intention, pull an oracle card which we use as confirmation and information for the intention we have set. We share at the end because the full healing is in the collective experience.
- Meditation/Journey
- Sound Healing
- Oracle Card pull & Share (optional)
- Ritual
- Raffle: One person will win a FREE healing session
The First and Third Monday of each Month
6:30pm to 8:30pm
6 Way Road, Middlefield, CT

December 2025

12/1/25

12/15/25

12/29/25

January 2026

1/5/26

1/19/26

February 2026

2/2/26

2/26/26

March 2026

3/2/26

3/16/26

3/30/26
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Age
Gender
How did you learn about this workshops?

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Date of Sound Healing Circle you are choosing*

MonthDayYear
Date
Have you ever participated in sound healing/bath? What was your experience like?
Do you have any health issues?*

MigrainesHigh Blood PressureHeart condition/pacemakerHearing problemsSeizure disorderOther
Pay via Venmo or cash exchange is $30 get $5 OFF

Venmo: Jessica-Alejandro-5
Pay via:

VenmoCash at door

My Products

Bi-Monthly Sound Healing Circle Product Image

Bi-Monthly Sound Healing CirclePay for one session or for more than one.

$35.00 Quantity

Bi-Monthly Sound Heling Circle Me & A Friend Product Image

Bi-Monthly Sound Heling Circle Me & A FriendBring a friend and get $5 off each

$60.00 Quantity

On-Line Participation via Zoom Product Image

On-Line Participation via ZoomZoom link will be e-mailed to you after registration is complete.

$25.00 Quantity

Pay via Venmo or Cash at Door Product Image

Pay via Venmo or Cash at DoorIf you’d like to pay via Venmo or cash day of the event. THIS IS NOT A FREE OPTION!

$ Free

Total

$0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Sound Healing Circle Liability Waiver
Facilitator: Jessica Alejandro, LMFT — Whole Heart Healing
Event: Monthly Sound Healing Circle

1. Participation & Purpose
I voluntarily choose to participate in the Sound Healing Circle. I understand that sound healing, meditation, and somatic practices support relaxation and personal growth and are not a substitute for medical or mental health treatment.

2. Health Responsibility
I am responsible for my physical, emotional, and mental well-being during this event.
I will inform the facilitator of any conditions (e.g., pregnancy, epilepsy, sound sensitivity, heart issues, injuries, mobility limitations) that may affect my participation.
I understand that sound healing may involve vibrations, guided practices, and physical/emotional sensations.

3. Assumption of Risk
I acknowledge and accept potential risks, including emotional release, discomfort, dizziness, fatigue, or resurfacing of past trauma. I choose to participate at a level that feels safe for me.

4. Liability Release
I release Jessica Alejandro, LMFT, Whole Heart Healing, the event space, and all assistants or affiliates from any liability for injuries, emotional distress, property loss, or any consequences arising from my participation, including risks related to ordinary negligence.

5. Confidentiality & Conduct
I agree to maintain confidentiality of all participants and to behave respectfully within the circle.
6. Media Consent

I consent to photos/video for promotional use.I do NOT consent.
7.Emergency Contact (name &Phone)
I have read and agree to this waiver.

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Sound Healing Registration Form & Waiver

Pay via Venmo or cash exchange is $30 get $5 OFF