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Winter Wellness Circle Waiver: RELAX, RESET AND RESONATE WAIVER

Network Spinal Analysis:

I request and consent to receive Network Spinal Analysis (NSA) chiropractic care in this office. I understand that NSA care is a low force chiropractic approach with features and benefits that are common with traditional chiropractic care, as well as some features and benefits that are unique to this approach.

NSA does not attempt to manually, or by instrument, manually adjust spinal misalignments. Instead, through enhancing my body’s self-awareness and strategies for adapting to stress, the body is better able to heal and make its own changes.

I understand that Network Spinal Analysis is a recognized chiropractic technique, with a body of research that supports it. I understand that the chiropractor in this office has been trained in traditional chiropractic techniques and is licensed to practice in Oregon.

I understand that as I receive NSA care I may find that I breathe more deeply and more fully. I may become more aware of my posture and find it changing. I may feel a different range of emotions. I understand that my pain or symptoms may continue, increase, or decrease along with reductions in defense patterns in the body.

This care does not seek to diagnose or correct any medical condition. Instead, through working actively with my practitioner, we seek to promote greater spinal and neural integrity and a decrease in stress posture and stress physiology. I am open to the experience of greater relaxation, less pain, more energy, and a greater sense of wellbeing.


Restorative Yoga:

I am participating in yoga classes, health programs, workshops and other wellness, exercise, and healing arts activities (collectively, the “Activities”) offered by Kat Gregory.

I recognize that I must be in good physical and mental health to participate in the Activities. I understand that the Activities require physical exertion, and I represent and warrant that I am physically fit and I have no medical condition which would prevent my full participation in the Activities. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Activities. If I have consulted a physician, I have taken the physician’s advice. I understand that Kat Gregory Yoga reserves the right in its absolute discretion to refuse my participation in an Activity on medical, fitness or other grounds.

I am in proper physical condition to participate in the Activities, and I am aware that participation could, in some circumstances, result in abnormal blood pressure, fainting, heartbeat disorders, physical injury and potentially heart attack. I also understand that I could experience muscle, back and other injuries during exercise. I understand my physical limitations and am sufficiently self-aware to stop physical activity before I become ill or injured. I understand that it is my continuing responsibility to inform Kat Gregory Yoga of any previous medical conditions, injuries, or surgeries prior to my first class and any future changes to my medical condition.

In consideration of being permitted to participate in the Activities, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the Activities with Kat Gregory.

In further consideration of being permitted to participate in the Activities, I  knowingly, voluntarily and expressly waive any “Claim” (as defined below) I may have  against Kat Gregory and the Studio, its owners, members, employees, and/or its instructors, teachers,  volunteer staff, interns, workshop presenters, independent contractors and the landlord of  the Studio (each, a “Released Party”) for any Claim that I may sustain as a result of  participating in the Activities with Kat Gregory at the Studio even if the Claim arises from the negligence  of any Released Party or anyone else. I agree to indemnify and hold harmless each Released Party from any loss or liability incurred in defending any Claim made by me or  anyone making a Claim on my behalf, even if the Claim is alleged to or did result from  the negligence of any Released Party or anyone else. “Claim” includes but is not limited to any and all liabilities, claims, demands, expenses, fees, legal actions, rights of actions for damages, personal injury, mental suffering and  distress, or death that I may suffer, my children may suffer or that my unborn child may  suffer (including any legal fees or expenses) in connection with participation in any  Activity.

I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue any Released Party for any Claim caused by any negligence or other acts of a

Released Party.

I hereby understand that Kat Gregory and the Studio from time to time may photograph or video classes or events occurring at its studios and place such photographs and videos on its Website. I hereby consent to the use of my image that may appear in any such photograph or video.

This agreement shall be construed in accordance with, and governed by, the laws of the State of Oregon.

I acknowledge that I have carefully read this release and waiver of liability and fully understand its contents. I voluntarily and knowingly agree to the terms and conditions stated herein. 


Sound Bath:

I acknowledge and agree that:

Session(s) can and may be beneficial to balance, harmonize, release, and heal on all physical, mental, emotional, and spiritual levels. I realize the therapeutic outcome of these treatments, individually and jointly, cannot be predicted with certainty and no guarantee is made regarding any particular result or outcome.

Prior to the session I will consult with my physician and receive written approval to attend healing sessions if I have metal in my body, suffered concussion/s, have a pacemaker, use an insulin pump, and the like.

I understand some bodily functions may temporarily be affected as a result of shifting energy within my body and I agree this is a natural occurrence.

I assume sole responsibility for my own health and for the results of this treatment provided by Trebled Souls LLC and that may affect my health in any way.

I have stated all my known medical conditions to Trebled Souls LLC and if necessary, I will keep Trebled Souls updated on my physical, mental, and emotional health. I acknowledge Trebled Souls practices for the purpose of providing mental/emotional/physical and spiritual support techniques.

All information received by me from Trebled Souls LLC is accepted with full knowledge that any action taken by me as a result of the information received is my complete responsibility.

I will raise any questions or concerns about anything I do not understand in relation to my session/s.

I release Trebled Souls LLC from all legal liability during my participation in all sessions today and going forward.

I agree to indemnify and hold harmless Trebled Souls LLC from any loss, cost or liability incurred in defending any claim made by me or anyone making a claim on my behalf, even if the claim is alleged to or did result from the negligence of Trebled Souls LLC.

All information discussed in all session(s) is confidential and will not be shared with any person(s) outside of session(s) without consent from me.

Healing and medicine are two separate disciplines. Crystal singing bowls, tuning forks, intuitive work are arts of healing, not the practice of medicine. In the case of any serious medical ailment or condition, you should always consult your physician for advice.

Trebled Souls LLC practitioners do not diagnose, perform medical treatment, make any medical claims, offer any guarantees, prescribe remedies or medication, or interfere with any form of treatment prescribed by a licensed medical professional.

I am aware that by signing this release and waiver of liability, I am giving up substantial rights, including my right to sue and certain legal rights my heirs, next of kin, executors, administrators and assigns may have against any Released Party. I fully understand and accept all its terms and conditions. I am willing to proceed with all sessions.

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