Name *

First Name

Last Name

I will e-transfer the payment of $150 for the whole session, or $112.50 for half the session to janelle.hacault@gmail.com to complete registration and receive the ZOOM link or use PayPal via this website in "Session Payment" *

Absolutely

I would like to be added to your newsletter/email list *

Yes please!

No, but thanks anyway :)

I realize that participation in the 2 Week Embodiment Session could involve some possible personal injury. Despite precautions, accidents and injuries may occur. By completing this registration and release form, I assume all risks related to the use of any and all spaces used by myself during the ZOOM online session. I agree to release and hold harmless Janelle Hacault, from any cause of action, claims, or demands now and in the future. I will not hold Janelle Hacault liable for any personal injury or any personal property damage, which may occur during or after class. Furthermore, I understand that I should be aware of my physical limitations and agree not to exceed them. By filling out this waiver, I authorize and agree that Janelle Hacault may take and use photographs/videos of me for the purposes of record keeping, advertising, and marketing. I understand that I do not have any rights to these photographs/videos and will not be compensated for the same. *

I have read and agree to the terms of this release waiver