Please fill out the following form
in order to participate in our activity.
Authorization And Release
As A Participant Of a Lite Touch Therapy Session, I Understand And Agree That I Am Fully Responsible For My Physical, Mental And Emotional Well-Being During My Sessions, Including My Choices And Decisions.
I Am Aware That I Can Choose To Discontinue Sessions At Any Time.
I Understand That A Lite Touch Session Is A Professional-Client Relationship I Have With My Coach That Is Designed To Facilitate The Creation/Development Of Personal, Professional Or Business Goals And To Develop And Carry Out A Strategy/Plan For Achieving Those Goals.
I Understand That A Lite Touch Session Is A Comprehensive Process That May Involve All Areas Of My Life, Including Work, Finances, Health, Relationships, Education And Recreation. I Acknowledge That Deciding How To Handle These Issues, Incorporate Coaching Into Those Areas, And Implement My Choices Is Exclusively My Responsibility.
I Understand That A Lite Touch Session Does Not Involve The Diagnosis Or Treatment Of Mental Disorders As Defined By The American Psychiatric Association. I Understand That a Lite Touch Session Is Not A Substitute For Counseling, Psychotherapy, Psychoanalysis, Mental Health Care Or Substance Abuse Treatment And I Will Not Use It In Place Of Any Form Of Diagnosis, Treatment Or Therapy.
I Understand That Certain Topics May Be Anonymously And Hypothetically Shared With Coaching Professionals For Training OR Consultation Purposes.
I Understand That A Lite Touch Session Is Not To Be Used As A Substitute For Professional Advice By Legal, Medical, Financial, Business, Spiritual Or Other Qualified Professionals. I Will Seek Independent Professional Guidance For Legal, Medical, Financial, Business, Spiritual Or Other Matters.
I Understand That All Decisions In These Areas Are Exclusively Mine And I Acknowledge That My Decisions And My Actions Regarding Them Are My Sole Responsibility.
I Hereby Certify That I Do Not Suffer From Any Physical Or Mental Disability That Might Affect My Participation In The Coaching/Healing Process, And, If I Have Any Substance Abuse Problem Or Mental Illness, I Have Consulted With My Physical And Other Health Care Professional And Been Advised That I May Participate In The Coaching/Healing Process Without Risk.
I Agree That If There Is Any Change In This Representation, I Will Promptly Advise The Lite Touch Practitioner.
I Agree That, In The Event Of Any Claim Or Grievance By Me Against Anna DeLuca Sole Remedy Will Be The Return Of The Unused Fees Paid To Anna DeLuca. Anna DeLuca Is Not Responsible For Any Direct, Indirect, Incidental Or Consequential Damages Beyond The Total Amount Of Fees Paid By The Client.
I Understand That By Scheduling With Anna DeLuca, That My Lite Touch Sessions Will Be Recorded by Request Only And Sent To Me by Email.
By Scheduling To Do A Session With Anna DeLuca I Am Committing To This Session And Will Be Charged 100% Of My Session Unless Canceled 24 Hours In Advance.