Child waiver form

Last updated on 04/11/2022

 

I, hereby release Catherine Jenkins (The hypnotherapist) from any liability or claims that could be made against her concerning the child mental and/or physical well-being during the work that has been outlined and agreed upon (now and in the future) by agreeing to these conditions. I also understand that Rapid Transformational Therapy and Hypnosis is not recommended for anyone suffering from psychosis, have an history of psychosis, schizophrenia, or epilepsy and If the child suffered from any of those conditions or is still suffering from it now, it will be made very clear to Catherine Jenkins.

Scope of Practice

 

I understand that Catherine Jenkins is not a licensed physician, psychologist, or medical practitioner of any kind and that hypnosis should not be considered a replacement for the advice and/ or services, of a psychiatrist, psychologist, psychotherapist, or doctor.
 

Participation
 

I give Catherine Jenkins full permission to hypnotize the child involved and to use Rapid Transformational Therapy (RTT). I am also committing to support the child involved to listen to their personalized recording for 21 days, as I understand that it plays an important role in the recovery success. 
 

Guarantee
 

I understand that although Rapid Transformational Therapy has an incredibly high success rate, Catherine Jenkins cannot and does not guarantee results since the child personal success depends on many factors that Catherine Jenkins has no control over, including the child willingness and desire to change.
 

Audio Recording(s)
 

I give Catherine Jenkins full permission to make audio recordings that may include the child voice. I understand that if a recording (or recordings) are made during or after the session(s), Catherine Jenkins retains full copyright over any forms of media that may be produced and distributed to me. 
 

Deepening Process (in-person)
 

I hereby grant permission to Catherine Jenkins to respectfully lift the child's arm, touch her/his shoulder, or rock her/his head during the session(s) in order to help facilitate the deepening process.

 

Confidentiality

 

By agreeing to this policy, I consent that Catherine Jenkins may release information to a specific individual or agency if it has been determined that a child or elder is at risk of or is currently being abused, or if the client is in imminent danger to myself or others; or if a subpoena of records has been requested. I also understand that, at any time, Catherine Jenkins may discuss aspects of the child's case with other colleagues keeping her/his full name and identity completely confidential. 
 

Cancellation

Please read our cancellation policy. 

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