Bearkuda & Asha Inc.

Waiver & Consent Form

Participants must be 18 years of age or older to take part in this session.

This form is valid and binding for the entire duration that you participate in our energy sessions. Should any of your information change, please let us know as soon as possible via email at info@bearkudaandasha.ca.

PERSONAL DETAILS

Full Name

Email Address

Mobile Number (with International Dialling Code)

Physical Address

City/Region

State/Province

Postal Code

Country of Residence

Date of Birth

Have you ever had an energy session before? Yes No

EMERGENCY CONTACT DETAILS

Full Name

Mobile Number (with International Dialling Code)

MEDICAL DISCLOSURE

Sharing this information is entirely optional. It simply helps us understand how to support you and adjust the session appropriately — you are never required to disclose anything you're not comfortable sharing.

Please disclose the following so we can support you appropriately during the session. This information is kept confidential.

If you are someone who receives regular care or assistance in your day-to-day life, we ask that a caregiver or support person be nearby during your session, in case they're needed.

Do you have epilepsy, a seizure disorder, a pacemaker or other implanted medical device, a heart condition, or are you currently pregnant? Yes No

If yes, please elaborate:

Energy work involves energy moving through the body, and seizures are understood as an energetic occurrence within the body, so it's possible that a session could trigger one. Please disclose if you have a history of seizures or a seizure disorder so we're aware, and understand that by choosing to proceed, you are accepting this as a known possible risk.

Do you have any metal in your body (e.g., surgical pins, plates, or other implants)? Yes No

If yes, please elaborate on what and where, so we can work around it:

Metal can heat up during energy sessions for some people, which is why we ask that it be removed where possible. If you'd rather keep something on, that's okay, just let us know below.

Do you plan to keep any metal jewelry on your body during your session (such as a wedding ring)? If so, please specify what you'd like to keep on:

EXPECTATIONS & INTENTIONS

What drew you to sign up for this energy session?

What are your intentions for the energy session?

If you'd rather keep your intentions private, that's perfectly fine. Just make sure they're spoken or thought of during the session.

What physical issues are you currently living with/experiencing? (For example: anxiety, chronic pain, or a specific diagnosis.)

THIRD-PARTY & GUARDIAN CONSENT

If you are signing up or requesting a session on behalf of someone else, you confirm that you are their legal guardian or otherwise legally authorized to make this decision for them, and that the person receiving the session has agreed to it themselves, to the extent they are able to communicate that agreement. A session is only directed toward, and only received by, someone who is aware of it and has consented to it. If someone is signed up without their knowledge or agreement, they will not be included in the session.

LIABILITY & WAIVER AGREEMENT

I understand that energy work is an alternative and complementary practice and is not a substitute for conventional or functional medical, psychological, or psychiatric treatment. I understand that Bearkuda & Asha Inc., its facilitator Caitlin A. Sikora, and any other practitioners and/or contractors engaged by Bearkuda & Asha Inc. to help facilitate a session are not licensed healthcare providers and do not diagnose, treat, or cure any medical or psychological condition. Words such as "healing" and "energy work" are used in the way they are commonly understood within the energy work and spiritual communities, and their use does not constitute a claim, promise, or guarantee that any medical condition, illness, or disease will be healed, treated, or cured. I understand that results and experiences vary from person to person and that no specific outcome is guaranteed. I agree that the choices and actions I take in response to these sessions are solely my own responsibility, and that Bearkuda & Asha Inc., Caitlin A. Sikora, and any practitioners and/or contractors engaged by Bearkuda & Asha Inc. will not be held responsible for any decisions I make based on these sessions. I agree to release, waive, and hold harmless Bearkuda & Asha Inc. and all of its facilitators and contractors, jointly and individually, from any and all claims, losses, liabilities, or damages arising from my participation in these sessions or any related communication.

SESSION SAFETY

For your safety, please do not operate heavy machinery or drive a vehicle during or immediately after a session. If you are receiving a session remotely, please do not participate as a passenger in a moving vehicle. The altered, relaxed state a session can bring on is a distraction risk for the driver and is not safe.

PRIVACY & CONFIDENTIALITY AGREEMENT

Due to the personal nature of these sessions, which may touch on private health and emotional matters, confidentiality is required of all participants. By signing up, you agree never to discuss, reveal, or share another participant's identity, health conditions, or personal disclosures outside the live session. Recording, screenshotting, or photographing any portion of the live session by attendees is strictly prohibited.

If another person (a caregiver, family member, or companion) is present with you during the session, please let them know that anything shared during the session is confidential. If privacy is a concern, consider having them use headphones or step out of the room during the live portion of the session.

RECORDING CONSENT

I understand that the energy work of this session may be recorded by Bearkuda & Asha Inc. for use in Bearkuda & Asha Inc. programs, including any joint programs or memberships offered together with other practitioners. I consent to this recording being made and used for this purpose.

I consent to being recorded as described above.

DATA PRIVACY COMPLIANCE (PIPEDA)

Bearkuda & Asha Inc. respects your right to privacy and handles personal information in accordance with Canada's Personal Information Protection and Electronic Documents Act (PIPEDA), which regulates how personal information is collected, processed, stored, shared, and destroyed. Your contact details and any health information you share are kept confidential and protected with reasonable security safeguards, and are never sold or shared with third parties beyond what is required to run these sessions. Your information is kept for as long as needed for legal, tax, or business record-keeping purposes. You're welcome to contact us with any questions about the personal information we hold by emailing info@bearkudaandasha.ca.

GOVERNING LAW

This agreement is governed by the laws of the Province of Alberta, Canada. Where a participant resides outside Canada, the applicable privacy and consumer-protection laws of that participant's country of residence are also recognized and respected. If any part of this agreement is found to be invalid or unenforceable, the remaining provisions will continue in full force. This document, together with any other signed waiver or intake form on file for you, represents the entire agreement between the parties on this subject.

ACKNOWLEDGEMENT & CONSENT

I have read, understood, and agree to the Liability Waiver, the Third-Party and Guardian Consent section, the Privacy and Confidentiality Agreement, the Recording Consent, the Data Privacy Compliance section, and the Governing Law section above, and I confirm I am 18 years of age or older.

I agree to receive emails from Bearkuda & Asha Inc., including updates and promotions. (required to sign up for a session)

Full Name of Person Attending the Session

Signature (type your full name)

Date

Location

If a guardian is signing on an attendee's behalf, please complete below:

Full Name of Guardian

Signature

Date

Location