Release Form

Please complete this form prior to attending your Experientials session.

Release Form

Name *

Email *

The Experientials session you are attending has been designed with the safety of yourself (and others if applicable) as the utmost priority. Using your body correctly while applying techniques, and how to apply said techniques in a way that accommodates the needs of yourself and/or a recipient will be explained to you. Even with these measures in place, difficulties can arise. You will be learning some bodywork and/or self-care techniques of a level suitable to your degree of knowledge and skill, and practising what you learn on yourself and/or another person, as will they on you. These techniques are potentially unsafe if not practised correctly. While every effort has been made to ensure the highest level of teacher/attendee interaction on the day, it is not always possible for Ana to observe every attendee at every moment. If you have any physical limitations that may affect your ability to give or receive bodywork and/or self-care techniques without injury, or if you are pregnant, please inform Ana immediately. On very rare occasions, recipients of bodywork/self-care techniques may have adverse reactions. Symptoms may include headaches, dizziness and muscle soreness, among others. You are in complete control of your own body and what happens to it; if you feel any of these symptoms or anything else that is causing you discomfort at any time, please inform Ana immediately so that she may take the appropriate action to correct the situation. By signing this release you are stating that you understand the inherent issues in participating in this session; you will inform Ana of any physical limitations you may have, including pregnancy; you release Ana Benedict from any and all liability relating to adverse effects that may occur from participation in this session. *

I agree

I understand that during the course of the Experiential session photographs may be taken and/or video footage recorded by Ana for the purposes of promotion and education, both online and offline. I agree to my likeness being used in this way. *

I agree

If you are human, leave this field blank.

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