I acknowledge that I have read and understood sections entitled, The Process, Training, and Licensure, Cancellation, Fees, and Privacy described above. I recognize that this is not in total psychotherapy and Ruth Kellogg is not a licensed physician and in no way does Ruth Kellogg provide legal, medical, or psychotherapeutic medical advice. It is my responsibility to secure such advisement. I acknowledge and agree that I assume the risks associated with any and all activities, classes and/or programs in which I (or my child) participate. Any claims, declarations and statements made on the website www.ruthkellogg.com
, also holds no guarantees.
I hereby acknowledge I (or my child) has volunteered to participate in a paid or unpaid session(s), class(es), workshop(s), or program(s) with Ruth Kellogg, to include, but also may not be limited to, any and all services provided, such as energy healing, spiritual and intuitive guidance, coaching, consulting, classes, programs, products, and workshop attendance. I further acknowledge that no promises have been made regarding results or desired outcome. In consideration of Ruth Kellogg’s agreement to instruct, guide, assist, advise, or train me, I do here and forever release and discharge and hereby hold harmless Ruth Kellogg, and her respective agents, from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my (or my child’s) participation in a session(s) or purchase of any program(s) without limitation, which may occur as a result of following advice provided or training rendered during a session or event.
I have consented to use the services offered by Ruth Kellogg, and agree to be personally responsible for the fees of Ruth Kellogg in connection with the services provided to me.
In order to use my services, please acknowledge receipt of the information provided in this form and sign it below. You can also respond by email by copying and pasting the paragraph below. Your receipt of information by email or below will act as your acknowledgment and signed agreement. You will receive a copy. Ruth Kellogg will keep the original in her records for at least three years.
Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Ruth Kellogg from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).
I acknowledge that I have read this waiver and release. I fully understand that it is a release of liability. By forwarding this by email or signing below I am waiving any rights I or my successors might have to bring legal action against Ruth Kellogg.
ELECTRONIC SIGNATURE AGREEMENT: By selecting the "I Accept" button below, you are signing this Agreement electronically and are legally bound to its terms & conditions. You agree your electronic signature is the legal equivalent of your manual written signature.