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  • COMPREHENSIVE INFORMED CONSENT AND MEDIA RELEASE AGREEMENT

    Session of Demonstration Recording and Public Distribution Agreement

  • 1. Parties

    This Agreement is entered into between:

    Provider: Rakel Kieding

    and Participant:

  •  

     2. Purpose of Agreement

    This Agreement governs the Participant's participation in a session that will be recorded and may be distributed publicly via YouTube, social media platforms, and advertising channels.

     


    3. Nature of Sessions

    • Sessions involve emotional/psychological exploration
    • Content may include personal, emotional, or sensitive material
    • Participant acknowledges this is NOT a substitute for ongoing clinical therapy

     

    4. Recording Consent

    Participant voluntarily consents to:

    • Audio and/or video recording of all sessions
    • Storage of recordings by Provider
    • Use of recordings for the purposes outlined below

     

    5. Media Distribution Rights

    Participant grants Provider the right to:

    • Edit, modify, or excerpt recordings
    • Distribute content on YouTube, social media, and advertising platforms
    • Use Participant's likeness, voice, and statements in connection with such distribution
    • Translate or subtitle content for broader audiences

     

    6. Scope of Use

    Recordings may be used for:

    • Educational purposes
    • Public awareness and outreach
    • Marketing and promotional materials

     

    7. Compensation

    • The session will be free of charge
    • No compensation will be provided for participation

     

    8. Privacy and Confidentiality

    • Provider will take reasonable measures to protect Participant identity where requested
    • However, Participant understands that once published, content may be viewed, shared, or archived by third parties beyond Provider's control
    • Provider will not disclose additional personal information beyond what appears in the recording

     

    9. Right to Withdraw

    Participant may withdraw consent:

    • Before publication: Written notice to Provider
    • After publication: Request for removal; Provider will make good faith efforts to comply but cannot guarantee removal from all platforms or third-party copies
    • Participant can ask to stop and have the recording discontinue at any point in time during a session.

     

    10. No Therapeutic Relationship Created

    • This Agreement does not establish a practitioner-client relationship.
    • Sessions are for educational/media purposes, not treatment.

     
    11. Risk Acknowledgment

    Participant acknowledges:

    • Potential emotional impact from public exposure
    • Possibility of unintended audience reach
    • Risk of comments, feedback, or engagement from viewers
    • No guarantee of positive reception

     

    12. Indemnification

    Participant agrees to indemnify Provider against claims arising from:

    • False or misleading statements made during sessions
    • Breach of third-party rights disclosed in sessions
    • Violation of this Agreement by Participant

     

    13. Governing Law

    This Agreement shall be governed by the laws of the City of Chico, California, USA

     

    14. Severability

    If any provision is found invalid, remaining provisions remain enforceable.

      
    15. Entire Agreement

    This document constitutes the complete agreement between parties regarding this matter, and supersedes all prior agreements, wether oral or written, relating to the subject matter herein. 

      
    16. Independent Legal Advice

    Participant acknowledges having had the opportunity to seek independent legal counsel before signing.

  • Your Date of Birth
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  • Date Effective (today)
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  • Format: (000) 000-0000.

  • Application:

    Some about you!
  • Although there can be many benefits to a session, it can also be a difficult process that leads to the opening up of emotional pain. This may disrupt your relationships and daily activities. As I accompany you in a session of demonstration, I will endeavor to create an attuned and safe container for any difficult material to be processed. Please discuss with me any concerns that you may have.                              Are you currently seeing a therapist who can follow up with you after the session if required?
  • Do you currently experience suicidal thoughts?

  • Certain principles are maintained during a session. These are:

    • The participant makes sure to have a private, uninterrupted and comfortable space for the duration of the session (not in a car), and stable internet.
    • The participant is encouraged to bring a specific intention to each session.
    • The participant determines how much to engage in the session and may request to pause or stop at any time.
    • The provider may interrupt the participant during the session to bring them into awareness of the present moment and to body sensations and emotions.
    • The provider follows the subtle cues of the participant.
    • The provider or the participant may slow the pace of the session any time.

     

    Rakel Kieding is a Compassionate Inquiry® Certified Practitioner and has completed The Compassionate Inquiry® Professional Training and Mentorship Program.

    She has also been certified by the International Coaching Federation as a PCC (Professional Certified Coach).

    While Rakel Kieding's work is heavily influenced by her training, she takes the liberty to branch into her own natural developement of exploration.

  • Thank you for your interest! I will be in touch to schedule a short consultation to further determine if we are a good fit for a session of demonstration.

    Rakel Kieding
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