Intake FormPlease complete the below before our session. Thank you and I’m really looking forward to working with you. Name * First Name Last Name Email * What is your intention behind our session together? Release stress/anxiety Feel calm/relaxed Nervous system reset All of the above None of the above Other Liability Waiver + Communication Consent * I, the undersigned, understand acknowledge these classes and practices use ancient healing techniques to reduce stress, and step into my full worth. I am aware that Melaina Gasbarrino (SALT to TREE - herein ‘the company’) will not prescribe substances, perform medical treatments or diagnose conditions, nor will the company interfere with any/all licensed medical professionals. If I have any physical or psychological alignment, the company recommends seeking treatment from a licensed medical professional. I hereby agree to the following: I, the undersigned, understand the benefits of receiving energy healing through sound bath meditations, reiki, yoga, etc., and am open to receiving the transformations felt by these practices. Through a sound bath meditation, I am aware that sound, vibration, and intention invite me to move from a waking state of consciousness (beta) to a highly relaxed state (alpha, theta, and delta). In this relaxed state, an individual's innate healing abilities can function more effectively, promoting optimal vibrational alignment and enhancing overall health and well-being. I have no medical condition(s) that would prevent my full participation in these classes. If there are any changes to my medical condition(s), I will immediately notify the company. In consideration for being permitted to participate in these classes and/or sessions, I agree to assume full responsibility for any risks, damages or injuries, known or unknown, which I might incur as a result of my participation in the companies offerings. Furthermore, I knowingly, voluntarily and expressly waive any claim I may have against the company, its owners, and instructors, for any injuries or damages I may sustain as a result of my participation. I agree that this agreement shall be governed by the laws of Ontario and if any conflict arises between me and the company, I will attempt mediation before submitting my dispute to binding arbitration. I have read the above release and waiver of liability and fully understand its contents and voluntarily agree to all of the terms and conditions. First Name Last Name Photography and Media Consent By attending this session(s), you grant the company the right to capture and use photographs, videos, or other media recordings of you for promotional, marketing, or any other lawful purposes without any compensation or approval required. Yes No Communication Consent * I agree to the receipt of email communications, including but not limited to announcements, event invitations and newsletters, from SALT to TREE using my given email address. Yes No Thank you for completing the intake form, I’m looking forward to working with you!