Release & Empower Online Waiver & Agreements
Welcome to the Release and Empower Women's Circle! Please read everything carefully and make sure you understand and agree before submitting. If you have any questions or concerns, contact me at info@juliaaziz.com before completing this form.

*Note: Make sure you add my email to your contacts list (otherwise it's possible that communications about the group will go to your spam or promotional folder). 

Sign in to Google to save your progress. Learn more
Email *
First and Last Name *
Phone Number *
WHAT THE PROGRAM IS, WHAT IT IS NOT, AND RISKS INVOLVED: The Release & Empower program is a container for personal growth and exploration. It is not psychotherapy, and does not involve medical treatment, psychological therapy or analysis of any kind. It's important you understand that the practices we do in the circle can be both gentle and intense, and there are certain risks involved. (1) There may be days when you leave feeling just wonderful, and days when you may access deep emotion and/or memories that need more integration afterward. If you are still integrating when we complete a call, you may need to give yourself more transition time, use the practices on your own, and/or reach out to your support network. If you are working through deep trauma, it is highly recommended that you have a therapist or other 1-1 professional support to help with this processing, as the women's circle is not a substitute for therapy. (2) There is a risk, albeit slight, of injuring yourself physically during the somatic release part of our work. In signing this form, you understand this risk, agree to stay mindful of your body and its particular vulnerabilities, and release and hold harmless me, Julia Aziz, from any and all liability, loss, damage, costs, claims, demands, and/or causes of action of every kind and nature, including but not limited to those for bodily injuries, out of or relating to your participation in this circle. (3) You are responsible for making sure your own physical space is safe and free of obstacles to movement. This includes caring for lit candles properly, clearing potential hazards that may be on the floor, and doing whatever other preparations are necessary to ensure you can move freely and safely. (4) If you ever feel you could use more 1-1 support from me, please reach out through email and we can schedule an appointment (options vary depending on your place of residence; fees can be found on my website).  *
Required
CONFIDENTIALITY: While vulnerability and honesty is encouraged, it is up to each woman to modulate her own sharing and to respect her own privacy. To this end, please understand that (1) Every participant is asked to keep what is shared within the group in deep confidence. At the same time, there is no way to guarantee this confidentiality, as each person must be in her own integrity and make her own agreement to it. (2) If you share that a minor under the age of 18, an elder 65 and older, or a person with disabilities is being abused or neglected, or that you are a danger to yourself or others, the appropriate legal authorities will be contacted. (3) Recording of our sessions is never permitted. Recording a meeting is grounds for dismissal from the community. (4) There are potential confidentiality risks that come with using any technology, including, but not limited to, interruptions and unauthorized access. You are responsible for your own safe use of technology as well as for the privacy of your space. (5) Sharing our video meeting link with anyone else is not permitted. Please respect the group space just as you would if we were meeting in person. (6) I don't share contact information in order to protect everyone's privacy, but you are welcome to make connections with other participants outside of our meetings on your own. Again, since this is not a therapy group, there may be participants who know each other or myself personally and/or professionally in different contexts.  *
Required
TIMING & ATTENDANCE: Please arrive on time for our first two meetings so you become familiar with the rhythm of the practices and oriented to the circle. In future weeks, it's completely fine if you need to arrive late; you can just join in wherever we are. You are always welcome to join the call, no matter how late you're running. Once you do arrive though, please try to stay for the entire meeting. (If, for some reason, you have to leave a session early, please let us know that when you first arrive). This keeps our space respectful of the sharing and provides a more protected container for community healing. You can expect our sessions to last about an hour and fifteen minutes. Attendance is always optional. Of course you are encouraged to come every week, as consistency with these practices provides the greatest benefit over time, but life happens and there will likely be a session here and there you need to miss. You don't need to tell me when you'll be out (or when you're running late), but if you miss more than 2-3 sessions in a row, it's helpful if you check in with me via email. *
Required
FEES: All fees are paid through your PayPal subscription. Once you sign up for the program, you are committing to pay for the full season(s) you signed up for. There are no refunds for payments already made and no payment cancellations mid-season. You can miss as many sessions as you need to, but there are no discounts for missed groups or late attendance. If you decide to stop attending the circle altogether, you are still responsible for completing all remaining payments in the subscription you chose. If you have any questions about these policies, please ask them before signing this form. By completing this form, you acknowledge and agree to these payment policies. *
Required
UNEXPECTED CANCELLATIONS BY GROUP LEADER: If I (Julia) am ever seriously ill or experiencing a personal/family emergency, I will contact you by email as soon as humanly possible. I will either (a) reschedule the upcoming session to one of the potential makeup session dates, (b) one of my trusted colleagues will facilitate the upcoming session on the date originally planned, OR (c) instructions on how to do self-practice with a playlist, recording, and/or written sharing option may instead be provided to replace our live session. Potential makeup session dates for Fall 2024 are as follows: Sunday October 27th at 11am CST and Sunday December 1st at 4pm CST. You can make a note of these potential dates now just in case, knowing cancellations are rare, and we likely won't use them. If some sort of extensive emergency occurs on my end, fees for cancelled sessions will be refunded as soon as possible.
*
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Julia Aziz. Report Abuse