Informed Consent | venitaramirez

Please complete this waiver to participate in the

Embodiment, Subtle Energy and Clear Light Retreat March 11-13, 2022

Thank you for taking responsibility for your emotional wellbeing and your boundaries.

Informed Consent & Liability Waiver
for Embodiment, Subtle Energy & Clear Light Retreat with Venita Ramirez

First Name

Last Name

Phone

Emergency Contact

Emergency Contact Phone #

I acknowledge that I am of sound mental and physical health. I have read the Approach section of Venita Ramirez' website and I understand that Venita Ramirez is not a licensed therapist or medical provider. I also understand that breathwork can surface intense emotions and memories and I take responsibility for regulating my participation in a way that feels safe for me.

Yes

Please share any limitations re: your mental and physical health.

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for the unlikely occurance of accidental injury or illness which I may incur as a result of participating in this retreat. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Thanks for submitting!

Informed Consent & Liability Waiver for Embodiment, Subtle Energy & Clear Light Retreat with Venita Ramirez

Informed Consent & Liability Waiver
for Embodiment, Subtle Energy & Clear Light Retreat with Venita Ramirez