soul conversation with kids® waiver and release form
Release & Waiver of Liability, Terms & Conditions, Authorization for Consultation
The Inn Method®, Melinda Iverson Inn, Melinda Inn Consulting
As the purchaser of this product or service, I certify that I am at least 18 years of age, of sound mental capacity, and understand and agree to the following:
My consultation with Melinda Iverson Inn is not a medical evaluation, diagnosis, prescription, treatment, or prognosis (“medical care”) or a substitute for medical care or other licensed health care. Melinda Iverson Inn, The Inn Method®, and all persons acting in conjunction with them at the event at which this consultation occurs, or otherwise, are not medical or licensed health care practitioners; do not provide medical care or health care in connection with this consultation; do not make any representation or promise regarding the effects or outcome of this consultation; and do not in connection with this consultation assume responsibility for any medical or health condition that I now have or may have in the future. I will not, based on this consultation, modify, suspend, or stop any medical care or licensed health care I am now receiving or may receive in the future, without first consulting an appropriate medical or licensed health care practitioner responsible for that care.
I have read and understand this document and authorize the consultation to which it pertains. This release and waiver is part of the consideration to Melinda Iverson Inn for this consultation, and Melinda Iverson Inn would not provide this consultation without this release and waiver. On behalf of myself, and my heirs, representatives, successors, and assigns, I release and waive any and all claims in connection with this consultation that I or they now have or may have in the future against Melinda Iverson Inn; the Inn Method®; the employees, contractors, and agents of Melinda Iverson Inn and/or the Inn Method® all persons and organizations advising, promoting, sponsoring, hosting, or otherwise involved with the event at which this consultation occurs; and their heirs, representatives, successors and assigns.
The duties of this consultant include: Duty to Protect (Based on the Tarasoff decisions), Duty to Inform (Informed Consent), Duty to Report (Child/Elder Abuse, Domestic Violence), Duty to inform of any threat of violence by the client to self or others. It my duty to interpret and report any of the mentioned comes up in session consultations.
If you understand and agree with the terms of this agreement, type your name and today's date below and click the "Accept" button. You will then be re-directed to Melinda's calendar.