By signing this form, I understand that yoga includes physical movements as well as an opportunity for relaxation, stress reduction, and relief of muscular tension. As is the case with any physical activity the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, adjust the posture, and ask for support from the teacher. I will continue to breathe smoothly.

Yoga is not a substitute for medical attention, examination, diagnosis, or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Leslie Whitecrow and/or Glowing Lotus Enterprises.

I have read, agree with, and will adhere to this information. Please have a parent/guardian sign if under 18 years old.

By signing this form, I give my consent to this energy session with Leslie Whitecrow. I understand that sessions may include a variety of modalities such as: Aromatherapy, Reflexology, Acutonics, Shamanism and Reiki. I understand that I may discontinue a session at any time. I understand and agree that Leslie Whitecrow is not a medical doctor, nor does she practice medicine. If I have been diagnosed by a licensed health professional as having any disease, injury or other physical/mental condition, I understand that I should inform my healthcare professional that I will be receiving these energy work sessions. I understand and agree that I will accept full responsibility for any negative outcome resulting from discontinuing any treatment or therapy prescribed by a licensed healthcare professional.

Energy Work Sessions can:
• Promote balance and normalization of the body naturally
• Reduce stress
• Improve circulation and stimulation of our own Innate immunity and healing


ENERGY WORK SESSIONS ARE NOT A SUBSTITUTE FOR MEDICAL CARE.  IF YOU ARE EXPERIENCING ANY SPECIFIC MEDICAL PROBLEM AND HAV NOT SEEN YOUR MEDICAL DOCTOR, I RECOMMEND YOU DO SO TODAY.

I hereby grant permission to Glowing Lotus Enterprises the rights of my image, in video or still, and of the likeness and sound of my voice as recorded on audio or videotape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published, or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording.

By signing this release, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet. I will be consulted about the use of the photographs or video recording for any purpose other than those listed above. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed. This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only. By signing this release, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.