DIANA VERGARA

Waiver, Consent & Liability Agreement for Coaching, Embodiment & Free Flow Movement Sessions
If you are not the person who will be attending, please complete the form below with the participant’s details,
and the terms and conditions must be accepted directly by the person attending the session.
IMPORTANT — PLEASE READ CAREFULLY
This agreement applies to all coaching, embodiment, and free flow movement sessions offered by Vital Balance Inc.
By signing this document, you agree to the following terms:
1. Not a Substitute for Medical or Psychological Care
I understand that the services provided by Vital Balance Inc. including coaching, embodiment practices, and movement exploration,
are designed to support personal awareness, emotional well-being, and inner growth.
However, I acknowledge that these sessions are not a substitute for professional medical, psychological, or psychiatric treatment.
If I am currently under the care of a physician, therapist, or psychiatrist, I confirm that I have consulted with them, if necessary,
before participating in this session.
2. Mobility, Injuries, and Physical Awareness
I agree to inform the facilitator of any physical conditions, injuries, or mobility limitations that may affect my ability to safely participate.
I understand that all movement practices are optional and can be modified.
I take full responsibility for listening to my body and honoring my physical limits during the session.
3. Emotional Sensitivity and Self-Care
I understand that coaching, embodiment practices,
and movement sessions may bring up emotions or insights that feel unexpected or tender.
These experiences are a natural part of reconnecting with the body and inner self.
I acknowledge that if strong emotions arise, I will care for myself with gentleness and seek additional support if I feel it’s needed.
While the facilitator offers a safe and respectful space, I recognize that this session is not a substitute for therapy.
4. Self-Responsibility and Informed Consent
I understand that I am participating in this session voluntarily and at my own risk.
I take full responsibility for my physical, emotional, and mental experience before, during, and after the session.
I agree to communicate clearly with the facilitator and take care of myself if I need to pause, modify, or stop at any point.
5. Waiver of Liability
I release and hold harmless Vital Balance Inc., its facilitators, employees, and representatives from any and all liability, claims,
or actions arising from my participation, to the fullest extent permitted by law.