VERSE

Client Informed Consent Waiver

Welcome! We are happy to have you experience the healing arts available through the Verse community of students and supervisors (“Practitioners”). Please complete this client waiver of liability prior to services. Your Practitioner specializes in natural remedies and health solutions, including private consultations and treatments in a safe and nurturing environment. They may integrate various healing modalities into a comprehensive holistic treatment plan specially designed for your education and wellbeing. The use of nutritional and herbal counseling are considered alternative procedures and are not a substitute for western medical care. Therapies or advice offered are not designed to be a diagnosis or treatment of any disease, injury or medical condition. Accordingly, if you have any medical or health issues, we strongly recommend that you consult your physician or healthcare provider with regard to any medical conditions or pharmaceutical interactions in addition to obtaining any information and/or treatment from your practitioner. Immediately discontinue use of herbs or treatments if you experience negative side-effects or discomfort.

RELEASE OF LIABILITY The individual named below (referred to as “I” or “me”) desires to receive services from Verse Practitioners. In consideration of the intangible value of participating in healing modalities (“Services”) and in recognition of reliance hereon, I agree to all the terms and conditions set forth in this Release. I hereby expressly waive and release any and all claims or damages I may have, whether known or unknown, against Verse, and its students, supervisors, officers, managers, employees, shareholders/members and agents (“Releasees”), including, but not limited to, any claims or damages arising out of or attributable to the Services, whether arising out of negligence or otherwise of Verse and all other Releasees or otherwise. I covenant not to make or bring any such claim against the Company or any other Releasee, and forever release and discharge the Company and all other Releasees from liability under such claims.

I understand that by signing this release, I am waiving any and all claims, of any kind arising out of or attributable to the Services, including those claims that may be unknown to me, or which I do not suspect to exist at this time. WITH THE INTENTION OF WAIVING ALL UNKNOWN AND UNSUSPECTED CLAIMS, I HEREBY EXPRESSLY WAIVE ALL RIGHTS, BENEFITS, AND PROTECTIONS I MAY HAVE UNDER CALIFORNIA CIVIL CODE SECTION 1542, WHICH READS AS FOLLOWS: A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.

ADDITIONAL ACKNOWLEDGEMENTS I hereby consent to and grant permission to Verse Practitioners to perform such evaluations and treatments considered necessary or advisable to determine the therapeutic information, treatments, services and/or products to prepare a comprehensive holistic treatment plan designed for me. I understand that I retain the right to question the purpose of the care, reasonable alternative forms of treatment and risks of the recommended care. I acknowledge that no guarantees have been or can be made regarding the likelihood or success or outcomes of any information, treatment, services and/or products provided to me. By signing below, I am requesting and consenting to treatment utilizing the principles and techniques of therapies to be performed by a professionally trained practitioner and acknowledge that I am at least 18 years of age.

COMMITMENT As a participant in Verse’s Advanced Mentorship Free Clinic, I commit to following through with the herbal and lifestyle protocol that is prepared for me by the teacher and the students. All communication between myself and the head clinician will be timely and accurate as to help the learning process of the Clinical students. All information is kept confidential between the head clinician, the students, and you, the client.