I understand that most participants suffer no adverse side effects from singing bowl or sound bath therapy; however, side effects can occur. By my signature and initials below, I acknowledge that I have read, understand, and agree to the following:

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• Only a limited number of controlled scientific studies have been done on singing bowl therapy or sound bath therapy, and hence the positive and negative effects both physiologically and psychologically are unknown. I acknowledge this fact and assume all physiological and psychological risks. I acknowledge that my participation is completely voluntary.

• Epilepsy: I understand that certain sounds may in some individuals trigger seizures. I accept all risks of such seizures which may occur while participating in singing bowl and/or sound bath therapy sessions.

• Metal implants: I understand that singing bowl vibrations might move or otherwise affect metal devices, causing injury or malfunction of the device. Such metal devices include pacemakers, coronary shunts, artificial heart valves, or metal pins or staples.

• Bodily conditions: I will inform the singing bowl/sound bath practitioner about the existence of known tumors, implants, screws or artificial joints, so that singing bowl placement can be avoided on or near these.

• Mental health: I understand that singing bowls/sound baths often elicit deep memories, emotion, and thoughts. If I have been diagnosed with a mental disorder like PTSD, anxiety, or depression, I will work with my doctor or therapist to make sure I can manage the thoughts and feelings that might arise from singing bowl/sound bath therapy.

• Skin conditions: If I have an inflammatory skin condition like psoriasis, eczema, or hives, I will inform the singing bowl/sound bath practitioner so singing bowls will not be placed on my body since they could aggravate the skin condition.

• Pregnancy: I accept all risks from participating in singing bowl/sound bath therapy while pregnant. If I am pregnant or suspect that I am pregnant, I will inform the singing bowl/sound bath practitioner so that bowl placement can be adjusted.

• Hearing damage: I acknowledge and accept that, while singing bowls are not played at "rock concert" volume, it is possible that some people might experience temporary or some degree of permanent hearing loss from singing bowl/sound bath therapy.

• Children: I accept all risks of allowing my children to participate in singing bowl/sound bath therapy.

• Surgery. If I have had surgery, I accept all risks of participating in singing bowl/sound bath therapy on the parts of my body affected by the surgery, and especially if I go ahead and participate in a singing bowl/sound bath therapy before my body is fully healed. I will inform the singing bowl/sound bath practitioner so that singing bowls can be positioned away from such areas of my body.

• Ongoing Health Problems. I will only use singing bowl/sound bath therapy as a complementary therapy and not the only therapy or treatment for my health problems or mental health issues. I will not delay or skip other treatment or therapy in order to use singing bowls/sound baths as a treatment. I will talk with my physician about any treatment I would like to try including singing bowl/sound bath therapy.

• I understand and agree that the singing bowl/sound bath therapy is not intended as a comprehensive treatment of physical or mental illness. _______ (Initials)

• I understand and agree that I have notified the singing bowl/sound bath practitioner of all known medical conditions and injuries. _________ (Initials)

• I agree to notify the singing bowl/sound bath practitioner of any changes in my health and medical condition. _____ (Initials)

• I understand and agree to communicate to the singing bowl/sound bath practitioner any physical or emotional discomfort during a session so that the sounds can be adjusted to my level of comfort. Having said that, I understand and agree that it is my responsibility to take care of myself, my body and my emotions at all times during the singing bowl/sound bath session. The practitioner is responsible only for giving a singing bowl/sound bath experience. _______(Initials)

• I acknowledge that a singing bowl/sound bath experience may exacerbate previously undiscovered injuries.______ (Initials)

• I understand and agree that I or the singing bowl/sound bath practitioner may terminate a session at any time. ________ (Initials)

• I have been given a chance to ask questions about the singing bowl/sound bath therapy, and my questions have been adequately answered. ________ (Initials)

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Given the foregoing, and for other good and valuable consideration, the receipt and sufficiency of which I acknowledge, I do hereby waive any and all liability for and indemnify and hold harmless Gigi Turner and The Sound Bath of the Rockies, LLC and its officers, directors, members, principals, employees, independent contractors, agents and volunteers (hereafter “Released Parties”) from and against any and all claims, demands, actions, causes of action, damages, obligations, losses and expenses of whatsoever kind or nature arising out of any services provided to me by the Released Parties. This waiver and release shall bind my heirs, personal representatives, successor and assigns.

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Client Date

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