Nouvelles Solutions New Client Registration
New Client Registration Form
Limit one person per session.
Email address *
Your age: I am 18 years of age or older. *
Birthdate *
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Please name the service you would like. And please write a brief description of the situation you would like addressed. A parent or guardian may request a session for a minor. *
Your answer
Full Name *
First and Last
Your answer
Street Address/City/State or Province/Country *
Your answer
Telephone number (and best time to call, in case I need to contact you by telephone) *
Format (555) 555-5555
Your answer
NOUVELLES SOLUTIONS, L.L.C. HOLD HARMLESS FORM In consideration of receiving energy therapy from Nouvelles Solutions, L.L.C., I hereby Release, Waive, and Discharge all rights to take legal action against and Covenant Not to Sue, and Agree to Forever Hold Harmless for any and all purposes, Nouvelles Solutions, L.L.C. and its owners, officers, agents, representatives, board members, stock holders, Jodi L. Waugaman, including any of her heirs or assigns, and/or employees (hereby collectively called the“Employees”) and each of them both in their official and individual/private capacities from Any and All Liabilities, Claims, and/or Demands, that may result from therapy provided by Nouvelles Solutions, L.L.C. and its Employees. I fully understand and appreciate the potential outcomes directly and/or indirectly inherent in receiving energy therapy. My election to receive energy therapy from Nouvelles Solutions, L.L.C. and its Employees is completely voluntary and at my own discretion. I also hereby acknowledge that Nouvelles Solutions, L.L.C. and its Employees do not make any promises that their methods will help or cure me of any type of health problem or condition. I voluntarily assume full responsibility for any risks or outcomes that may result from receiving energy therapy, whether caused by commission or omission on the part of Nouvelles Solutions,L.L.C. and its Employees.it is my express intent that this Covenant Not To Sue and Hold Harmless agreement shall bind the members of my family, spouse, heirs, owners/masters and their families and personal representatives. In agreeing to this Covenant Not To Sue and Hold Harmless agreement, I acknowledge and represent that I have read the foregoing Covenant Not To Sue and Hold Harmless agreement, understand it, and voluntarily agree to it and its terms in full as my own free act and deed; no oral representations, statements, or inducements apart from the foregoing agreement that has been reduced to writing have been made. I execute this document as full, adequate and complete fully intending to be bound by the same, now and in the future. By completing the information below and signing this document, I agree to the Hold Harmless conditions stated above. In the event of a dispute or disagreement, I consent to the exclusive jurisdiction and venue of a court of competent jurisdiction in Kittanning, Pennsylvania, and to the exclusive laws of the Commonwealth of Pennsylvania, United States of America. Disclaimer: ​There is no guarantee that Jodi Waugaman's services will solve a particular condition. I, Jodi Waugaman, disclose to the client(s) in this written statement using plain language the following information: 1) I am not a licensed physician. 2) I do not diagnose, treat, prevent, or claim to heal/cure any situation. 3) The treatment is alternative or complementary to healing arts services licensed by the state. 4) The services I provide are not licensed by the state. 5) The nature of the services to be provided are based on spiritual and energetic healing. 6) You, the client(s), assume all responsibility for outcomes, or the lack thereof, and you do not hold Jodi Waugaman in any way responsible. Consult licensed medical/health care professionals for any and all physical, mental or emotional health issues.7) By requesting a reading or any one of Jodi's services, you understand and agree that Jodi Waugaman is not a medical professional, attorney, accountant or other licensed professional, and cannot give medical, legal or tax or financial advice. Any information or advice given by Jodi Waugaman is not to be used by you in place of any medical, legal, tax or financial advice or diagnosis from qualified and licensed professionals in those fields. Readings by Jodi Waugaman are intended to offer insight into your personal life, and do not in any way constitute medical, legal, financial or tax advice. Jodi Waugaman will not be held liable for any damages resulting from the use of this website or as a result of any reading or service provided by Jodi Waugaman, or any persons or events related thereto and/or any actions or decisions that you make as a result, including without limitation, actual, incidental, and/or consequential damages resulting from any claims resulting from any act or omission, negligence, fraudulent misrepresentation or otherwise, including without limitation, personal injury, death, loss of income, stress (emotional or otherwise), errors or omissions, or otherwise. *
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Today's Date *
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A copy of your responses will be emailed to the address you provided.
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