Practitioner: Dr Jen Draper
Session Date: {q12_datetime10}
( Enter below your provisional preferred date - unconfirmed without email confirmation from info@wellbeingholistic.net )

Please read each section carefully and confirm your agreement before signing.

I understand that Vādma sessions may involve physical touch, somatic and nervous system work, emotional release, and other physical, emotional, psychological, or energetic responses. I acknowledge these inherent risks and confirm that I am fully responsible for my own physical, emotional, and psychological wellbeing during and after the session.
I also understand that not everyone is suitable to receive a Vādma session, and that if I am deemed unsuitable, then my session fee will be refunded, less any costs for administration.

I, for myself and on behalf of my heirs, executors, administrators, and personal representatives, hereby waive, release, discharge, and hold harmless the Vādma practitioner providing the session, Vādma LLC, its owners, directors, trainers, representatives, contractors, successors, and assigns from any and all claims, demands, actions, losses, damages, costs, expenses, injuries, illness, trauma, emotional distress, psychological distress, or consequences arising out of or in connection with my voluntary participation in this session, to the fullest extent permitted by law. I understand that the session is provided by the practitioner in their own independent professional capacity, unless expressly stated otherwise in writing by Vādma LLC.

I understand that the practitioner providing the session is not responsible for any changes, cancellations, delays, or interruptions caused by events beyond their reasonable control, including but not limited to natural disasters, illness, emergencies, venue issues, travel disruptions, pandemics, government restrictions, or other force majeure events.

This agreement is governed by the laws of New South Wales, Australia. Any disputes arising in connection with this agreement or a Vādma session provided by Dr Jen Draper will be subject to the exclusive jurisdiction of the courts of New South Wales.

I understand that while Vādma LLC is an international organisation, Dr Jen Draper operates as an independent practitioner in Australia and this agreement reflects that independent capacity.

I confirm that I do not currently have, and to the best of my knowledge have no history of, any medical condition, contraindication, or circumstance that would make participation in a Vādma session unsafe, including but not limited to:

- Cardiovascular disease, atherosclerosis, hypertension, or history of stroke

- Any cardiac condition, including arrhythmia, heart failure, or unstable heart symptoms

- Recent heart attack or stroke

- Active blood clots, deep vein thrombosis, or pulmonary embolism

- Recently placed or unstable arterial stent

- Active use of blood-thinning medication, including Warfarin, Rivaroxaban (Xarelto), Heparin, or similar medication

- Pacemaker or implanted cardiac device

- Acute fever or active infection

- Pregnancy, suspected pregnancy, or possibility of pregnancy

- Current intoxication or recent use of alcohol, recreational drugs, or plant medicine

- Severe psychiatric condition, psychosis, suicidal ideation, untreated trauma crisis, or severe dissociation

- Any other physical, emotional, psychological, or medical condition that may affect my ability to participate safely

 

If any of the above applies to me, I agree to disclose this to the practitioner before the session begins. I understand that written clearance from a qualified medical professional may be required before a session can proceed.

I acknowledge that the practitioner reserves the right to decline to offer a session based on information submitted in this form, any prior communication, or assessment conducted upon meeting in person.

If a session does not proceed for any of the above reasons, a refund will be issued minus any administration or travel costs reasonably incurred by the practitioner.

I understand that Vādma sessions are not a substitute for licensed medical, psychological, psychiatric, therapeutic, or clinical care.

I affirm that I am fit to participate and have consulted a qualified doctor, therapist, or mental health professional if I have any condition that may be relevant to my participation.

I take full responsibility for my own medical, emotional, and psychological wellbeing before, during, and after a session.

By signing this form I specifically confirm that I am physically fit enough to walk up three flights of stairs without limitation, shortness of breath, chest discomfort, or need to stop.

I agree not to use alcohol, recreational substances, or plant medicine before or during the session. I understand that failure to comply may result in immediate removal from the session without refund.

I understand that Vādma sessions are intimate and vulnerable spaces. I agree not to record - audio or video - anything that happens during the session without the explicit prior permission of the practitioner, Vādma, and all other participants present. Failure to respect this may result in immediate removal from the session without refund.

I understand that on occasion, Dr Jen Draper may offer a discounted or complimentary session in exchange for permission to film the session for educational and promotional purposes.

I understand that if I accept such an arrangement:

• The session may be recorded - audio and/or video - by the practitioner or their nominated person
• Footage may be used on social media, websites, and other promotional or educational materials
• I will be informed prior to the session that filming will take place and given the opportunity to withdraw my agreement before the session begins
• Withdrawing agreement prior to the session means the discounted or complimentary arrangement will no longer apply
• Once filming has occurred and footage has been published I cannot withdraw consent retrospectively
• If desired, my eyes may be obscured in any published footage to protect my identity while still allowing the session to be used for educational and promotional purposes.
  
  

I give permission for the practitioner named in this form to collect, store, and use my personal data, including my name, email, phone number, session information, waiver responses, and any health or safety information I voluntarily provide, for the purpose of managing my participation, ensuring relevant safety considerations, maintaining session records, and communicating with me regarding my session.

I understand that my data will be stored securely and will not be sold or shared unnecessarily. I understand that I may request access, correction, or deletion of my data by contacting the practitioner responsible for my session.

Where applicable, this information may be shared with Vādma LLC only for legal, safety, certification, quality assurance, or administrative purposes.

I have read, understood, and agree to all of the above. I confirm that I am voluntarily participating and take full responsibility for myself. 

I acknowledge that I have read and understood this agreement and enter into it voluntarily and with full informed consent.