Release & Empower Online Community Agreements
Welcome to the Release and Empower Online Community! Please read everything carefully and make sure you understand and agree before submitting. If you have any questions or concerns, please contact me at before completing this form.
Email *
First and Last Name *
Phone Number *
WHAT THE PROGRAM IS, WHAT IT IS NOT, AND RISKS INVOLVED: The Release & Empower Program is a container for personal growth. It is not psychotherapy, and does not involve medical treatment, psychological therapy or analysis of any kind. Emotional release and personal healing work can be both gentle and intense, and there are certain risks involved. (1) There may be days when you leave feeling just wonderful, but you also may access deep emotion and/or memories of past experiences that need more integration afterward. The program will not be sufficient in supporting you through deep trauma work. If you need further support and are not already working with a psychotherapist, you are welcome to schedule an individual session with me (TX residents only), or I can refer you to some of my wonderful colleagues. (2) There is a risk, albeit slight, of injuring yourself physically during the somatic release part of our work. In signing this form, you understand this risk, agree to stay mindful of your body and its particular vulnerabilities, and release and hold harmless me, Julia Aziz, from any and all liability, loss, damage, costs, claims, demands, and/or causes of action of every kind and nature, including but not limited to those for bodily injuries, out of or relating to your participation in this circle. You are also responsible for making sure your own physical space is safe and free of obstacles to movement. *
CONFIDENTIALITY: While vulnerability and honesty is encouraged, it is up to each woman to modulate her own sharing and to respect her own privacy. To this end, please understand that (1) Every participant is asked to keep what is shared within the group in deep confidence. At the same time, there is no way to guarantee this confidentiality, as each person must be in her own integrity and make her own agreement to it. (2) If you share that a minor under the age of 18, an elder 65 and older, or a person with disabilities is being abused or neglected, or that you are a danger to yourself or others, the appropriate legal authorities will be contacted. (3) Recording of our sessions is never permitted. Recording a meeting is grounds for dismissal from the community. (4) There are potential confidentiality risks that come with using any technology, including interruptions and unauthorized access. (5) Sharing our Google Meet link with anyone else is not permitted. Please respect the group space just as you would if we were meeting in person. *
TIMING & ATTENDANCE: Please arrive on time for our first meeting so you become familiar with the rhythm of the practices. In future weeks, it's completely fine to arrive late and just join in wherever we are. Once you join us, please stay for the remainder of the meeting. If, for some reason, you do have to leave early, just communicate that in the chat box. This keeps our space respectful of the sharing and provides a more protected container for community healing. You can expect our sessions to last around an hour and fifteen minutes, sometimes a little less, sometimes a little more. Also, please know attendance is optional. Of course you are encouraged to come every week, as consistency with these practices provides the greatest benefit over time, but life happens and there will likely be a session here and there you need to miss. You don't need to tell me when you'll be out, but if you miss more than one or two sessions in a row, it's helpful if you check in with me via email. *
FEES: All fees are paid through your PayPal subscription. Once you sign up for the program, you are committing to pay for the full season(s) you signed up for. There are no refunds for payments already made, no payment cancellations mid-season, and no discounts for missed groups or late attendance. If you have any questions about these policies, please ask them before signing this form. By completing this form, you acknowledge and agree to these payment policies. *
ORIENTATION: There is an online orientation video that will be emailed to you, along with a video link for our sessions. You are asked to watch the video before your first time in the community. Please save that email, as well as the one that will come with a copy of this waiver, in case you need to reference this information in the future. *
A copy of your responses will be emailed to the address you provided.
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