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Mandala Hills Waiver Form

Please read and sign 

INFORMED CONSENT, RELEASE, AND LIABILITY WAIVER

 

I confirm that I provided completely and entirely accurate information.

I am voluntarily visiting Mandala Hills (Bachman Ranch, LLC) and participating in activities there with the knowledge that there are risks and dangers involved, including the possibility of injury, property damage, or even death from many possible causes, including the aggravation of existing symptoms, forces of nature, wildlife, accident or illness without rapid evacuation or adequate medical supplies or services, stolen or lost property, and unknown causes that neither I nor Mandala Hills can anticipate.

If I am under the care of a psychologist, psychiatrist, or doctor for any mental health or physical illness or diagnosis, I obtained their approval to participate in all activities in which I will engage at Mandala Hills.

Officers, employees, members, managers, agents, and volunteers of Mandala Hills are not licenses healthcare professionals.  They are not qualified to diagnose illnesses, prescribe substances, or perform medical treatment.  The services they offer are considered complimentary to, and not a replacement for, traditional western medical practices.

Sound healing sessions may involve the placement of vibrating objects near or on the body that emit very high- or low-pitched frequencies, and light therapy involves emitting low-level pulsed light frequencies to parts of the body.  These activities may aggravate certain symptoms, cause light-headedness, and provoke mood changes.

If I experience any discomfort, pain, or injury while engaging in an activity at Mandala Hills, I will immediately inform an authorized representative of Mandala Hills.

In addition to sound healing and light therapy, other activities in which I may participate at Mandala Hills, including energy work, yoga, meditation, psychic readings, massage, and acupuncture are methods to work on my well-being.  I recognize that these types of activities carry risks.  There are no guarantees of what I will experience.  These activities may cause me to deal with problems in my life or uncomfortable feelings.  My participation may cause me to experience heightened emotional or physical sensations, memories, agitation, or feelings of sadness, guilt, frustration, loneliness, or helplessness.

If I experience any uncomfortable sensations or feelings while at Mandala Hills, I will immediately inform an authorized representative of Mandala Hills and, if I am no longer at Mandala Hills, I will immediately contact a licensed healthcare professional.

We look forward to seeing you!

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