Name * First Name Last Name Phone (###) ### #### Email * You will be added to the email list to receive updates about my practice as well as any upcoming New Moon gatherings. How did you hear about us? * DISCLAIMER * We respect all clients regardless of their age, gender, race, national origin, sexual orientation, religion, socioeconomic status, body type, political affiliation, state of health or personal habits. You must be 18 years of age to attend this space or accompanied by a guardian if you are under 18 years of age. All participants will be treated with respect and dignity. Privacy and confidentiality are maintained at all times. I understand that this is a women's only space with the exception of mother's bringing young children. I respect and uphold this choice. Please let the facilitators know if you have any contagious condition or any health concern that necessitates modifying or declining your session. The bodywork sessions to be administered are for the purpose of stress reduction, relief of muscular tension, increasing circulation, and promoting a feeling of general relaxation. The bodywork or assessment or herbal care done by Cierra Dunn (Inner Rhythms Body Wisdom), does not diagnose illness, disease, physical or mental disorders, nor does the therapist(s) prescribe medical treatment or pharmaceuticals, nor do they perform spinal adjustments or in anyway attempt to perform the functions of a medical doctor. Clients must agree to accurately inform the therapist of the status of their health, and agree to keep them updated on their current level of health and well-being. There shall be no liability upon and to hold harmless Cierra Dunn and their relatives, successors, and heirs for any condition which may result from receiving therapeutic massage, bodywork, or using the sauna in this space, or from leaving, arriving, and occupying the building and its surrounding premises. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by my mere presence within this interaction or establishment and that such exposure or infection may result in personal injury, illness, permanent disability, and/or death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others at this event. I hereby release the facilitators and business from any and all claims arising from or in connection with any direct COVID-19 impact during the services and exchange. I know that I am sovereign in this space to determine what is true and feels good for me. I affirm that I have read, understand, and agree to the disclaimer above. I understand and am comfortable with partial nudity of other women and maintain the right to choose for myself what my level of comfortability is. I understand and agree. Thank you fro submitting this form. An email will be sent to you shortly with details about our next gathering! New Moon RSVPThank you for making the choice to circle with us!