Client Release and Waiver Agreement
Section 1. Certification of Identity: I certify that I am: (a) At least 18 years of age, (b) Not acting in the capacity of a reporter or agent for any form of news media, (c) Not a registered sex offender, and (d) I have not been convicted of a violent crime.
Section 2. Safety and Comfort: I agree to hold this cuddle session in a clean, safe, secure, and comfortable environment. I understand that (THE PRACTITIONER) may decline to provide or terminate
a session at her sole discretion and for any reason, including but not limited to reasons of comfort or safety, at any time.
Section 3. Nonsexual Environment: No sexual activity shall be permitted. I agree to remain fully clothed, and behave in a non-sexual manner at all times. I understand that, although intimate, sessions are strictly platonic and nonsexual.
Section 4. Voluntary Participation; Respect for Boundaries: I agree that (a) my attendance at this session is voluntary and for my personal enjoyment only, (b) I will not engage in any nonconsensual, touching, badgering or intimidation of any kind, (c) I am/will refrain from taking drugs or alcohol before, and be sober during, my session, and (d) I will comply with any and all federal, city, state or county laws, statutes or regulations during my session. I understand it is my responsibility to know and communicate my general state health and any conditions or special limitations that may affect my session.
Section 5. Payment, Reschedule & Cancellation: Payment is expected at the start of each session. Payment can be made online or paid in cash at the time of the session. I understand that if a situation arises in which I must cancel my appointment, I need to provide at least 24 hours notice. Cancellations and re-scheduled session will be subject to a full charge if NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for a session, you may lose some of that session time.
Section 6. Indemnification & Waiver of Liability: I hereby agree to release, waive, hold harmless, and indemnify (THE PRACTITIONER) from any and all claims, loss, liability, costs, or damages to personal or physical property, of any nature, whether known or unknown, in law or in equity, which may arise in, from, or related to the course of any cuddle session or any other services provided to me by (THE PRACTITIONER).
Section 7. Assumption of Risk: I assume full responsibility for any risk of bodily injury, illness, psychological or emotional harm, death, or property damage, to myself or others, arising from my attendance or participation in this cuddle session and any cuddle sessions or any other services provided to me by (THE PRACTITIONER) whether caused by any participant in the cuddle session or otherwise. Without limiting the foregoing, I acknowledge and understand that this session may explore new emotional concepts and may involve situations in which I feel uncomfortable, and willingly assume that risk.
Section 8. Safety: I understand that our session will be kept confidential. However, I also understand that for security reasons, my address and contact information will be made available to a trusted third party who will access it only if necessary.
Section 9: Social Media & Confidentiality: Due to the importance of confidentiality and the importance of minimizing dual relationships, I understand that (THE PRACTITIONER) does not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). Adding clients as friends or contacts on these sites can compromise my confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it. We can establish warmth and friendliness, but we cannot become personally involved outside of the therapy setting. This extends to social media. In order to protect your confidentiality, should we see each other outside of the therapy setting, I, (THE PRACTITIONER) will only acknowledge that I know you if you choose to greet me first, in which case I will respond in kind.
I HAVE READ AND FULLY UNDERSTOOD THIS RELEASE AND WAIVER OF LIABILITY, AGREE TO AND/OR ACKNOWLEDGE THE TERMS,
REPRESENTATIONS, AND INFORMATION SET FORTH ABOVE, AND FREELY AND VOLUNTARILY SIGN BELOW. I UNDERSTAND THAT BY SIGNING BELOW, I MAY BE GIVING UP SUBSTANTIAL RIGHTS AND I INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
**Client MUST acknowledge they read and agree to this on the Client Consent Form.