RELEASE FORM:

I understand that the level of my participation in this Healing program I perform must be determined by me, in consultation with my physician, and that the healer/counselor cannot fully monitor the extent of my participation or the after affects of my session. I agree to allow Ariah Velasquez to perform healings on me in our private session. If there is something I do not want Ariah Velasquez to do, I agree I will be responsible to ask her not to do it.

I understand that the counselor is not a physician, nurse or emergency medical technician, and that the counselor by making this program available, is not undertaking any responsibility regarding my medical condition(s). If my medical condition should change, I understand that it is my responsibility to discontinue the program/sessions and to immediately consult with my physician about continuing or resuming participation in this program/sessions.

I hereby release, indemnify and hold harmless Ariah Velasquez, the Blissful Life Counseling from any and all claims, demands, personal injuries, costs or expenses, arising out of my participation in this program/session.

I understand that I would not be accepted in this program without the execution of this Release. I have read this Release and been given the opportunity to ask any questions. I have received and understand the information which was provided