INFORMED CONSENT

I understand that Trauma Informed Channeling, Existential Exploration, and Energy Alignment may include the following with my permission:

• Channeling the Unified Field of Consciousness

• Yoga therapy

• Body sensing

• Qi Gong

• Qi massage

• Mindfulness skill building

• Meditation practices

• Breath practices

• Reiki

• Tuning forks

• Singing bowls

• Primal voice release

• Soul conversations

• Perception pruning & seeding

• Intuitive development exploration

• Other energy alignment modalities informed by the individual needs and preferences of each co-creator

Mindful movement is a very personal practice and is used to both identify stuck patterns in the mind, heart, and body as well as release those patterns energetically. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated.

May these be our agreements:

“I understand that while engaging in mindful movement I will do so at my own pace.”

“I will listen to my body, modify the movement or posture, and ask for support. I will continue to allow the body to breathe as my body comes to a more easeful state.”

“If at any point I feel overexertion or fatigue, I will respect my body’s voice and needs and I will rest before continuing the movement practice.”

*Mindful movement not a substitute for medical attention, examination, diagnosis, or treatment. Some movements are not recommended and are not safe under certain medical conditions. Please be clear about any medical conditions you may be experiencing so we may co-create the safest possible session to support your healing.

“I affirm that I alone am responsible to decide whether to practice mindful movement.”

Tuning Forks shift the frequency of our vibration and increase energetic input. This can feel overwhelming and can even be harmful, especially if you have any of the following. Identifying these conditions prior to tuning fork alignments creates a safe and effective experience to unfold. Forks vary in frequency and uses and can be adapted to meet the needs of those with the following:

• Active Cancer

• End-of-Life

• Pregnancy

• Electrical Medical Implants such as pacemakers, Medtronic pumps, and neural implants

• Recent concussions

• Metal toxicity

• Varicose veins

• Dental anomalies like dental implants, chipped/broken teeth, or bone fragments in the gums

• Fractured bones

• Metal Implants

“I will reveal any of these conditions prior to receiving tuning fork therapy allowing space for co-creating a safe exploration and treatment of the body during the session.”

I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Kim Gebro, LLC and Kim Gebro. I acknowledge that participation in mindful movement sessions expose me to a possible risk of personal injury. I am fully aware of this risk and hereby release Kim Gebro, LLC and Kim Gebro from any and all liability, negligence, or other claims arising from or in any way connected with my participation in mindful movement and/or meditation sessions.

My signature further acknowledges that I shall not now or at any time in the future bring any legal action against Kim Gebro, LLC or Kim Gebro; and that this waiver is binding on me, my heirs, my spouse, my children, my legal representatives, my successors, and my assigns. My signature at the end of this form verifies that I am physically fit to participate in movement therapy and a licensed medical doctor has verified my physical condition for participation in these types of activities. If I am pregnant or become pregnant or am post-natal, my signature verifies that I am participating in mindful movement with my doctor’s full approval. I realize that I am participating at my own risk.