Consent Form
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Client Agreement for Services, Disclosures &
Consent for Animal Communication and Energy Medicine Sessions
Contact: [email protected] (503) 522-5453
Definition of Animal Communication and Energy Medicine
Animal communication, often called "intuitive" or "telepathic" communication, is a way to connect with animals on an energetic level beyond observing their physical behaviors. Many people find that tuning into an animal’s thoughts, feelings, or energy strengthens their bond, creates deeper understanding, and can sometimes reveal underlying needs or emotions.
Energy Medicine is a holistic integrative approach intended to clear, balance, and energize the pet or human energy system in order to facilitate physical, emotional, mental, and spiritual self-healing.
The trained practitioner uses various energy modalities with heart-centered intention. Communication and Energy Medicine is intended to complement and not replace any prescribed medical care. Practitioners do not diagnose conditions or prescribe treatment.
Session Information
Sessions vary in length and fees per session are defined when booking a session.
Marla Santino is not a provider for any insurance carrier and upon request will provide an invoice that the client may submit. There is no suggestion or guarantee of coverage.
Appointment Cancellation Policy
I agree to give a 24-hour notice if it is necessary for me to cancel an appointment. My practitioner reserves the right to charge me for the session if sufficient notice is not given.
Confidentiality
All client information and records are treated in a confidential manner and no information will be released to anyone without my prior written consent, except in situations governed by law.
Disclosures
I certify that the facts herein are true and correct. I understand that these courses and sessions, including Animal Communication, are not intended to replace orthodox medicine or proper psychiatric care, but rather to complement and enhance them. If symptoms persist or are severe, I will consult a competent medical professional or veterinarian immediately. I understand that this session or course is intended to inform and educate only. No diagnosing, prescribing or curing is intended or implied. I also understand that the information presented is copyrighted, so No Video or Audio Taping is Allowed unless provided by 4Pettalks.
Marla Santino, 4PetTalks, a subsidiary of CRC Experience is a member of the
Energy Medicine Professional Association (EMPA)
Hold Harmless Clause
Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless, Marla Santino and 4PetTalks, from and against any and all claims or liability of whatsoever kind or nature arising out of, or in connection, with my session(s).
Client Consent for Sessions
By scheduling a session with Marla Santino and 4PetTalks you agree that:
___ (initials) I have read this document and been given the opportunity to ask questions regarding this document and Energy Medicine sessions.
___ (initials) I take responsibility to inform my practitioner of any changes in my health status.
___ (initials) Yes, I give permission for light touch.
___(initials) My questions have been answered to my satisfaction regarding my Energy Medicine student’s background, the method(s) they use, and what I might expect from this session.
By attending this event and participating in a remote or in person session, as the Participant and on behalf of myself and my principals, representatives, employees and agents, I AGREE THAT BY SCHEDULING A SESSIONR OR ATTENDING THE COURSE, I AM KNOWINGLY, VOLUNTARILY, AND EXPRESSLY WAIVING MY RIGHT, AND THAT OF MY REPRESENTATIVE, TO BRING OR MAINTAIN ANY ACTION AGAINST OR RECOVER FROM Marla Santino, 4PetTalks, Spirit Farm and Gardens AND ITS/HIS/HER/THEIR RESPECTIVE OWNERS, SHAREHOLDERS, MEMBERS, DIRECTORS, OFFICERS, MANAGERS, TRUSTEES, EMPLOYEES, AGENTS, AND REPRESENTATIVES, OR ANY OF THEM, FOR ANY INJURY TO ME OR MY DEATH, ANY INJURY TO MY MINOR CHILD OR HIS/HER DEATH AND THE LOSS OF OR DAMAGE TO MY PROPERTY AND/OR THE PROPERTY OF MY MINOR CHILD RESULTING FROM OR ARISING OUT OF MY PARTICIPATION AND/OR THAT OF MY MINOR CHILD IN ANY WORKSHOP ACTIVITY PROVIDED OR SPONSORED BY Marla Santino, 4PetTalks, INCLUDING BUT NOT LIMITED TO BEING IN, NEAR, OR WITH ANY ANIMALS DURING THIS WORKSHOP, ANY AND ALL OF THE INDIVIDUALS AND ENTITIES REFERENCED IN THIS PARAGRAPH ARE COLLECTIVELY REFERRED TO HEREINAFTER AS THE “RELEASED PARTIES.” THIS AGREEMENT OF RELEASE INCLUDES, BUT IS NOT LIMITED TO, CLAIMS BASED UPON NEGLIGENCE. I AGREE THAT BY SIGNING THIS AGREEMENT OF RELEASE, I AM KNOWINGLY, VOLUNTARILY, AND EXPRESSLY WAIVING MY RIGHT, AND THAT OF MY REPRESENTATIVE, TO BRING OR MAINTAIN ANY ACTION AGAINST OR RECOVER FROM THE RELEASED PARTIES FOR ANY INJURY TO ME OR MY DEATH, ANY INJURY TO OR THE DEATH OF MY MINOR CHILD AND/OR DAMAGE TO MY PROPERTY AND/OR THAT OF MY MINOR CHILD RESULTING FROM OR ARISING OUT OF MY/MY MINOR CHILD’S PRESENCE AT OR USE OF THE PREMISES. THIS AGREEMENT OF RELEASE INCLUDES, BUT IS NOT LIMITED TO, CLAIMS BASED UPON NEGLIGENCE. I also agree that as a condition of and in consideration of acceptance of entry, Marla Santino and 4PetTalks and Spirit Farm and Gardens may use or assign photographs, videos, audios, cable-casts, or other likenesses of me and my dog taken during the course of the event for the promotion, coverage or benefit of the event. I hereby expressly and irrevocably waive and release any rights in connection with such use, including any claim to compensation, invasion of privacy, right of publicity, or to misappropriation. I agree to provide updated and current information in the event any the status of any of the conditions changes. I understand that I am responsible for my own safety. I expressly accept all risks associated with this activity and voluntarily assume full responsibility for all the consequences of my choosing to engage in. I hold Marla Santino and 4PetTalks harmless for any death, injury, damage, or loss which I (or any minor on whose behalf I sign this contract) might suffer as a result of participation in this process, including any injuries or damages which result from another's negligence or fault. I have read and accept the terms of this liability disclaimer agreement.
Consent for Animal Communication and Energy Medicine Sessions
Contact: [email protected] (503) 522-5453
Definition of Animal Communication and Energy Medicine
Animal communication, often called "intuitive" or "telepathic" communication, is a way to connect with animals on an energetic level beyond observing their physical behaviors. Many people find that tuning into an animal’s thoughts, feelings, or energy strengthens their bond, creates deeper understanding, and can sometimes reveal underlying needs or emotions.
Energy Medicine is a holistic integrative approach intended to clear, balance, and energize the pet or human energy system in order to facilitate physical, emotional, mental, and spiritual self-healing.
The trained practitioner uses various energy modalities with heart-centered intention. Communication and Energy Medicine is intended to complement and not replace any prescribed medical care. Practitioners do not diagnose conditions or prescribe treatment.
Session Information
Sessions vary in length and fees per session are defined when booking a session.
Marla Santino is not a provider for any insurance carrier and upon request will provide an invoice that the client may submit. There is no suggestion or guarantee of coverage.
Appointment Cancellation Policy
I agree to give a 24-hour notice if it is necessary for me to cancel an appointment. My practitioner reserves the right to charge me for the session if sufficient notice is not given.
Confidentiality
All client information and records are treated in a confidential manner and no information will be released to anyone without my prior written consent, except in situations governed by law.
Disclosures
I certify that the facts herein are true and correct. I understand that these courses and sessions, including Animal Communication, are not intended to replace orthodox medicine or proper psychiatric care, but rather to complement and enhance them. If symptoms persist or are severe, I will consult a competent medical professional or veterinarian immediately. I understand that this session or course is intended to inform and educate only. No diagnosing, prescribing or curing is intended or implied. I also understand that the information presented is copyrighted, so No Video or Audio Taping is Allowed unless provided by 4Pettalks.
- Energy Medicine practitioners do not diagnose conditions or prescribe treatments.
- No specific claims will be made by the practitioner regarding the results from the energy sessions.
- Goal(s) for our work together will be mutually identified as part of the assessment and clients have input in the goal-setting process.
Marla Santino, 4PetTalks, a subsidiary of CRC Experience is a member of the
Energy Medicine Professional Association (EMPA)
Hold Harmless Clause
Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless, Marla Santino and 4PetTalks, from and against any and all claims or liability of whatsoever kind or nature arising out of, or in connection, with my session(s).
Client Consent for Sessions
By scheduling a session with Marla Santino and 4PetTalks you agree that:
___ (initials) I have read this document and been given the opportunity to ask questions regarding this document and Energy Medicine sessions.
___ (initials) I take responsibility to inform my practitioner of any changes in my health status.
___ (initials) Yes, I give permission for light touch.
___(initials) My questions have been answered to my satisfaction regarding my Energy Medicine student’s background, the method(s) they use, and what I might expect from this session.
By attending this event and participating in a remote or in person session, as the Participant and on behalf of myself and my principals, representatives, employees and agents, I AGREE THAT BY SCHEDULING A SESSIONR OR ATTENDING THE COURSE, I AM KNOWINGLY, VOLUNTARILY, AND EXPRESSLY WAIVING MY RIGHT, AND THAT OF MY REPRESENTATIVE, TO BRING OR MAINTAIN ANY ACTION AGAINST OR RECOVER FROM Marla Santino, 4PetTalks, Spirit Farm and Gardens AND ITS/HIS/HER/THEIR RESPECTIVE OWNERS, SHAREHOLDERS, MEMBERS, DIRECTORS, OFFICERS, MANAGERS, TRUSTEES, EMPLOYEES, AGENTS, AND REPRESENTATIVES, OR ANY OF THEM, FOR ANY INJURY TO ME OR MY DEATH, ANY INJURY TO MY MINOR CHILD OR HIS/HER DEATH AND THE LOSS OF OR DAMAGE TO MY PROPERTY AND/OR THE PROPERTY OF MY MINOR CHILD RESULTING FROM OR ARISING OUT OF MY PARTICIPATION AND/OR THAT OF MY MINOR CHILD IN ANY WORKSHOP ACTIVITY PROVIDED OR SPONSORED BY Marla Santino, 4PetTalks, INCLUDING BUT NOT LIMITED TO BEING IN, NEAR, OR WITH ANY ANIMALS DURING THIS WORKSHOP, ANY AND ALL OF THE INDIVIDUALS AND ENTITIES REFERENCED IN THIS PARAGRAPH ARE COLLECTIVELY REFERRED TO HEREINAFTER AS THE “RELEASED PARTIES.” THIS AGREEMENT OF RELEASE INCLUDES, BUT IS NOT LIMITED TO, CLAIMS BASED UPON NEGLIGENCE. I AGREE THAT BY SIGNING THIS AGREEMENT OF RELEASE, I AM KNOWINGLY, VOLUNTARILY, AND EXPRESSLY WAIVING MY RIGHT, AND THAT OF MY REPRESENTATIVE, TO BRING OR MAINTAIN ANY ACTION AGAINST OR RECOVER FROM THE RELEASED PARTIES FOR ANY INJURY TO ME OR MY DEATH, ANY INJURY TO OR THE DEATH OF MY MINOR CHILD AND/OR DAMAGE TO MY PROPERTY AND/OR THAT OF MY MINOR CHILD RESULTING FROM OR ARISING OUT OF MY/MY MINOR CHILD’S PRESENCE AT OR USE OF THE PREMISES. THIS AGREEMENT OF RELEASE INCLUDES, BUT IS NOT LIMITED TO, CLAIMS BASED UPON NEGLIGENCE. I also agree that as a condition of and in consideration of acceptance of entry, Marla Santino and 4PetTalks and Spirit Farm and Gardens may use or assign photographs, videos, audios, cable-casts, or other likenesses of me and my dog taken during the course of the event for the promotion, coverage or benefit of the event. I hereby expressly and irrevocably waive and release any rights in connection with such use, including any claim to compensation, invasion of privacy, right of publicity, or to misappropriation. I agree to provide updated and current information in the event any the status of any of the conditions changes. I understand that I am responsible for my own safety. I expressly accept all risks associated with this activity and voluntarily assume full responsibility for all the consequences of my choosing to engage in. I hold Marla Santino and 4PetTalks harmless for any death, injury, damage, or loss which I (or any minor on whose behalf I sign this contract) might suffer as a result of participation in this process, including any injuries or damages which result from another's negligence or fault. I have read and accept the terms of this liability disclaimer agreement.