Acknowledgement and Waiver of Liability
Astrolight Healing and Tyler Bernard

I, _____________________________________, hereby certify and agree as follows:
I accept full responsibility for my health and voluntarily complete this Acknowledgement and Wavier of Liability.
I certify that I am seeking the consultation, healing, intuitive and or spiritual advice/impressions, teachings and treatment services of Tyler Bernard and Astrolight Healing for alternative healing therapies and intuitive counseling, which I fully understand are not medical or psychological diagnoses or treatments or substitutes for medical or psychological diagnoses or treatments.
I certify that with respect to any medical or psychological conditions or concerns I may have, I have been advised to consult with my medical physician or psychological/psychiatric health care professional and I understand that Tyler Bernard is not a primary care physician and I do not view him as my physician.  His practice specializes in a natural and spiritual approach to healing including, but not limited to energetic and hands on healing, intuitive/spiritual consultations and coaching, and teaching classes of a spiritual/metaphysical nature.  I understand that Tyler Bernard does not handle medical conditions or emergencies.
I agree that if I am taking any medications while under treatment with Tyler Bernard of Astrolight Healing, I will not change them without consulting my medical or psychological health care professional or physician.  I also understand that email is not confidential, secure or 100 percent reliable.  If I have an urgent question, I will call Tyler Bernard’s office at Astrolight Healing.  If I feel it is an emergency, I understand that I need to call 911 or go to the nearest emergency room.  I further agree and warrant that if at any time during a session I believe the conditions to be unsafe, I will immediately inform Tyler Bernard and discontinue further participation in the service.  I acknowledge my full responsibility to advise Tyler Bernard with respect to my levels of comfort or discomfort and any other information which might influence his support of me.
I understand and accept that several energy healing techniques used by Tyler Bernard or by other practitioners, volunteers, associates or other students involved with Astrolight Healing, may involve physical touch to my body and that some techniques may be administered entirely within my energetic field (area around the outside of, but not touching my body).  The private areas of my body are always respected and will not be touched directly by Tyler Bernard or other practitioners, volunteers, associates or students involved with Astrolight Healing.  I give my permission (or not, see below), to be touched for the purpose of receiving a private (individual session) or group healing (as a part of a class or group situation) on other areas of my body such as my head, arms, abdomen, legs, back, hands, feet, etc. for the sole purpose of receiving healing as described above.  I acknowledge and agree that if, at any time, I feel uncomfortable or unsafe I will immediately discontinue participation in the session, group or class I am attending.
I AGREE/GIVE PERMISSION to be touched, as outlined in the above paragraph by marking an X and my initials on this line _________________
I DO NOT AGREE/GIVE PERMISSION to be touched anywhere on my body, I mark an X and my initials on this line ___________________
I understand and agree that neither Tyler Bernard nor Astrolight Healing make any claims whatsoever, expressed or implied, regarding effects, results or outcomes of the treatment and/or consultation services and therapies (outlined above) provided and shall not be liable for same.  I certify that I seek the advice and treatment of Tyler Bernard and Astrolight Healing solely in my personal capacity, and do not represent any governmental agency, law firm, attorney, or investigator.  I am not involved in a lawsuit nor am I gathering information for a potential lawsuit.
I understand and agree on behalf of myself, my dependents, heirs, administrators, legal representatives and assigns, to release and hold harmless Tyler Bernard and Astrolight Healing and any and all associates, employees, agents, representatives, associates and volunteers thereof, from any and all liability for illness, injuries or death, and for any losses or damages relating thereto, however occurring, in relation to my consultation, with and/or treatment by Tyler Bernard and Astrolight Healing.  Without limitation, I understand and agree that neither Tyler Bernard nor Astrolight Healing nor any associates, employees, agents, representatives, associates nor volunteers thereof, are liable for any direct, indirect, consequential or incidental damage, injury, death, loss, delay, or inconvenience of any kind which may be occasioned by reason of any act or omission, including, without limitation, any willful or negligent act or failure to act, or breach of contract.
My signature below acknowledges that I am over 18 years of age and that I have carefully read and reviewed this Acknowledgement and Waiver of Liability, and I fully understand all of its terms and conditions; I recognize and accept all risks and limitations involved in seeking advice, consultations, teachings and treatment/healing techniques from Tyler Bernard and Astrolight Healing and all employees, agents, representatives, associates and volunteers thereof; I have not relied upon any other promises, agreements or representations by Tyler Bernard and Astrolight Healing, or any associates, employees, agents, representatives, associates or volunteers thereof concerning the treatment (consultations, coaching, healing techniques) provided or the terms of this Acknowledgement and Waiver of Liability; I have been encouraged by Tyler Bernard to seek advice of legal counsel concerning the Acknowledgement and Waiver of Liability; and I execute and deliver this Acknowledgement and Waiver of Liability freely and voluntarily and without duress or coercion and with full knowledge of the representations contained herein and the rights, legal and otherwise, relinquished, surrendered, released and discharged hereunder.
UNDERSTOOD, ACCEPTED AND AGREED.

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Client’s Signature		Client’s Name (Printed)		Date

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Witness’ Signature		Witness’ Name (Printed)		Date