PranaHorse & nwPranaPets Healing Pod submission form

(how did you hear about Healing Pod?)

I, THE UNDERSIGNED FOR MYSELF OR ON BEHALF OF ANY MINOR INDICATED BY ME BELOW, AGREE TO THE FOLLOWING: I understand that Energy Healing / Pranic Healing® practitioners are not licensed physicians or surgeons, and Pranic Healing® treatments are not licensed by the state but are complementary to healing arts services licensed by the state. That Energy Healing / Pranic Healing® practitioners do not physically touch the recipient’s body, diagnose diseases, prescribe any drugs/substances or make any health claims or guarantee any outcomes. That although this is a healing modality, and the goal is to improve my health, I understand that unexpected or unanticipated results may occur. That Energy Healing / Pranic Healing® is not meant to replace conventional medicine but rather to complement and enhance it. If symptoms persist, I agree to consult a medical professional. I agree to provide updated and current information in the event any the status of any of the conditions (listed above) 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 Energy Healing / Pranic Healing®. I hold Heart to Heart Healing, LLC dba PranaHorse and dba nwPranaPets, its owner Liza Burney, and their employees, volunteers and agents 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. Photography waiver I also agree that as a condition of and in consideration of acceptance of entry, Liza Burney and/or Heart to Heart Healing, LLC, dba PranaHorse, dba nwPranaPets may use or assign photographs, videos, audios, cable-casts, or other likenesses of me and my horse, dog or cat 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 hold Heart to Heart Healing, LLC, dba PranaHorse, dba nwPranaPets and Liza Burney 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. I have read and accept the terms of this liability disclaimer agreement.