Waiver for sound healing

For certain activities, attendees will be asked to sign a waiver. This is necessary for our insurance.

Participant Agreement, Assumption of Risk & Duty of Care

Provider: Maia Hart

Location: River Haven, Park Lane, Millstream, Qld 4888

1. Nature of Activity & Statutory Framework

I understand that Sound Healing involves lying down or sitting while listening to instruments such as crystal bowls, gongs, and chimes. This waiver is entered into voluntarily and is intended to have effect under the Voluntary Assumption of Risk Act 2002 (Qld). I understand this activity is not a substitute for medical or psychological diagnosis, treatment, or therapy. The facilitator does not diagnose, prescribe, or perform medical treatment.

2. Specific Risks of Sound Healing

I understand that sound vibrations can have physical and psychological effects. The particular risks associated with this activity include, but are not limited to:

- Strong vibrations affecting medical implants such as pacemakers

- Emotional release, crying, or unexpected psychological responses

- Changes in heart rate or blood pressure

- Headache, dizziness, or nausea

- Aggravation of sound sensitivity or tinnitus

3. Health Conditions & Who Should Not Attend

I understand that this session may not be suitable, or may require medical clearance, if I have any of the following:

- Pacemakers or other medical implants

- Pregnancy (especially first trimester)

- Epilepsy or seizure disorders

- Severe mental health conditions (e.g., psychosis, PTSD) where altered states may be destabilising

- Recent surgeries or acute physical injuries

- Sound sensitivity (including with autism) or tinnitus

4. My Responsibilities & Disclosure

I confirm that:

- I have read and understood this waiver and I voluntarily assume the risks listed above.

- I am responsible for consulting my own medical practitioner if I have any doubts about my suitability.

- I will advise the facilitator before the session if I am pregnant, have a pacemaker, experience seizures, or have any condition that could be affected by sound or vibration.

Participant Signature: ___________________ Date: _______

Print Name: ___________________

Emergency Contact Name & Phone: ___________________

If under 18: Parent/Guardian must also sign.

Parent/Guardian Signature: ___________________ Date: _______

Print Name: ___________________