Informed Consent Form
Informed Consent, Participation Agreement & Waiver
Welcome. I am honoured to work with you.
I offer a facilitated space for reflection, sharing, and integration around birth, postpartum, and life’s transformative passages. This is a relational and educational container, not a clinical or therapeutic service.
Please read the following carefully and sign at the bottom:
1. Confidentiality, inclusivity, and respect
This space is rooted in confidentiality, inclusivity, and mutual respect. By choosing to participate, you agree to uphold these principles within the space.
2. Scope of Practice
I am a somatic and integration practitioner, traditional postpartum care practitioner, Reiki Master, mentorship provider, and circle host.
I am NOT a licensed medical provider, psychotherapist, or mental health professional.
The guidance, education, and reflections offered are not intended to diagnose, treat, or replace medical or psychological care.
3. Your Autonomy & Personal Responsibility
You are the authority of your own body and experience.
By participating, you acknowledge that you are responsible for your own physical, emotional, and psychological wellbeing.
You are invited to engage in a way that honours your capacity, including pausing, stepping away, or choosing not to participate in any part of the experience.
4. Nature of the Work
My spaces may include emotional reflection, storytelling, and exploration of personal experiences, including birth.
While many find this work supportive and meaningful, it can also bring forward strong emotions or memories.
You agree to participate at your own pace and to care for yourself as needed.
5. Not a Substitute for Professional Care
This offering is NOT a substitute for individualized medical, psychological, or therapeutic care.
If you are experiencing significant emotional distress, trauma symptoms, or mental health concerns, you are encouraged to seek support from a qualified healthcare provider.
This space is NOT equipped to support individuals in acute crisis.
6. Group Integrity & Confidentiality (if applicable)
Confidentiality, inclusivity, and respect are key to group offerings that feel safe.
You agree to honour the privacy of others by not sharing personal stories or identifying details outside of the circle.
While confidentiality is a shared agreement, it cannot be absolutely guaranteed. By participating, you accept this shared responsibility and risk.
7. Consent to Participate
Your participation is voluntary.
By booking and joining, you acknowledge that you have read and understood this agreement and choose to participate willingly and at your own discretion.
8. Touch & Physical Contact (if applicable)
Some offerings may include optional, consensual touch as part of the work (for example, in body-based or hands-on practices).
You will always be asked for explicit consent prior to any physical contact, and you have the right to decline or withdraw consent at any time.
9. Online Participation & Recordings (if applicable)
For online gatherings, you are responsible for choosing your level of visibility (camera on/off) and participation.
Sessions are NOT recorded unless explicitly stated in advance, and your consent will be requested if recording is planned or added.
10. In-Person Gatherings in Private Homes (if applicable)
Some in-person offerings take place in a private residence (my home, a host’s home, or your own home), rather than a commercial venue.
By attending and/or hosting, you acknowledge and accept that:
The space is a lived-in environment and may not have the same features as a public or commercial facility.
You are invited to move through the space with care and awareness (including floors, stairs, entryways, and shared areas).
You assume responsibility for your personal belongings.
As a participant, you are invited to enter and move within the home with care, respect, and awareness, as a guest in a lived-in space.
As a host, if the offering takes place in your home, I will enter and move within your space with care and respect, and will ask all participants to do the same.
By choosing to attend or host, you accept any inherent risks associated with being in a private home setting and release the facilitator and host from liability related to the physical space, to the fullest extent permitted by law.
11. Cancellation & Refund Policy
All purchases are final unless otherwise stated.
If you are unable to attend, please notify me as soon as possible. Transfers or credits may be offered at my discretion.
12. Release of Liability
To the fullest extent permitted by law, you release the facilitator from any liability related to your participation in this offering.
By agreeing to this, you acknowledge that you are choosing to participate voluntarily and assume full responsibility for your experience.
Agreement
By typing your name and information below, you confirm that you have read, understood, and agree to the consent form.