Master Consent Form
SESSION DISCLAIMER

Although the information provided during intuitive sessions is profoundly accurate, each individual possesses free-will and is therefore capable of affecting outcomes. Sessions are provided as entertainment only. Beyond A Dream, LLC, its owner, agents, and affiliates decline responsibility, legal or otherwise, for any actions taken or not taken as a result of information obtained or interpretations made arising from intuitive sessions. Clients, through execution of the Beyond A Dream, LLC Master Consent Form take full responsibility for his/her own actions.

ONLINE CONSENT

I verify that the information in the completed Online Master Consent Form is current and accurate to the best of my knowledge. I also understand that any information provided is for identification purposes and will be kept strictly confidential, except that such information may be used by Beyond A Dream, LLC for statistical analysis or scientific research.

I understand that services offered at Beyond A Dream, LLC are not intended to diagnose, treat, cure, prevent, or heal any medical condition, disease, or injury. I also understand that intuitive readings are for entertainment purposes only. I understand that no one is 100% accurate and agree not to hold Beyond A Dream, LLC or Rev. Leeann Lilly, RM liable for anything said or done as a result of information obtained during my visit/session.

I hereby give my consent to receive services at/from Beyond A Dream, LLC and acknowledge and agree that I am doing so at my own risk. My health and safety with respect to such services are my sole responsibility. I acknowledge that my receipt of the services from Beyond A Dream, LLC may result in bodily injury to me, up to and including death. My decision to receive services from Beyond A Dream, LLC is voluntary, and I know of, understand, and assume any and all risks associated therewith.

In exchange for receiving services from Beyond A Dream, LLC, I, for myself, and on behalf of my heirs, executors, administrators, and personal representatives, hereby waive, release, discharge, and hold harmless Beyond A Dream, LLC, its members, officers, employees, and agents from any and all liability for any and all injuries including death, damages or claims relating to or resulting from my receipt of services, now or in the future, foreseen or unforeseen. Further, I will indemnify and hold Beyond A Dream, LLC, its members, officers, agents, and employees, harmless from and against any and all claims, rights, damages, liabilities, losses, costs, and expenses (including attorney’s fees) arising from or in connection with any injuries to other persons or damage to property caused by or attributed to me.

I acknowledge that I have read and understand fully the release and indemnification provisions set forth in the preceding paragraphs and agree to such terms. I also agree to review and comply with the service-specific information, procedures, and applicable utilization rules prior to each visit.

To proceed, please complete the form below. **If completing for a minor, complete with the information of the minor. Sign electronically with the following: [your name] for [name of minor], [relationship/legal authority] {Ex: Jane Doe, for Joe Child (Mother)}

Email address *
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Address *
Your answer
Authorization
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service