Consent & Release for Minors

Sacred Medley Intuitive Coaching, LLC

Welcome! I am looking forward to supporting your minor child. Your minor child’s safety and comfort is of the utmost importance to me. I request that your minor child participate in only those activities that he or she is physically, mentally, emotionally, and spiritually able to do, and that you notify me of any restrictions you may have regarding any of the Activities for your minor child, and I will do my best to accommodate them.

The form below must be read, electronically completed and submitted by you, the parent or legal guardian, if your minor child is under 18-years old. No minor child will be allowed to participate in a Sacred Medley Intuitive Coaching 1-1 Coaching, Classes and Camps with Sacred Medley Intuitive Coaching, LLC without the form being electronically submitted. It is important the information is on file for my immediate access.  Please read the following information carefully and let me know if you have any questions before submitting the form. 

For individuals of all ages. 

-During scheduled 1-1 Coaching, Classes and Camps,  I meet with adults ages 18+, with children ages birth - 13 years old with their parents present, and with children ages 14-17 years old with OR without parents (their choice). 

-During Ms. Jess Camp for Kids, I meet with children ages 3-12 years old without their parents present. 

-All parents and minors ages 2-17 will complete this Consent & Release for Minors form below.

1-1 Coaching, Classes and Camps  may take place at the Sacred Medley Intuitive Coaching space, private residences, homeschooling locations,  local organizations, schools, libraries, outdoors and anywhere that aligns with Sacred Medley Intuitive Coaching, LLC offerings. 

Consent, Release and Waiver

I voluntarily consent to my minor child’s participation in 1-1 Coaching,  Classes and Camps  organized by Sacred Medley Intuitive Coaching, LLC. In exchange for my minor child’s participation in the Service and/or use of the property, facilities, and services provided during the Service, I consent and agree to the following:

Voluntary Participation & Assumption of Risk. I fully understand and consent to the voluntary participation by my minor child in 1-1 Coaching, Classes and Camps. I take full and sole responsibility for my minor child’s life and well-being and all decisions made before, during and after the 1-1 Coaching, Classes and Camps. I acknowledge that my minor child is choosing to participate voluntarily in the 1-1 Coaching, Classes and Camps and I recognize that if there is a Reiki orYoga component, while planned with care and love, may contain certain inherent physical risks. I understand that my child can opt out of receiving Reiki and Yoga pose adjustments any time and that this will be honored by Sacred Medley Intuitive Coaching, LLC.  I agree that I expressly assume the risks of the 1-1 Coaching, Classes and Camps in which my minor child participates. I am also aware that if there is any Activity that I am not comfortable with my minor child participating in, or my minor child is not participating in, that my minor child may voluntarily decline to participate if he, she or I wish.

Rules and Warnings. My minor child and I agree to observe and obey all posted and announced rules and warnings, and further agree to follow any instructions or directions given and facilitated by Sacred Medley Intuitive Coaching, LLC. I give my minor child permission to view this Website and its Content for purposes that align and support the Services my minor child may receive in 1-1 Coaching, Classes and Camps. 

Not a Substitute for Medical Advice. I understand that the information provided at or in conjunction with the 1-1 Coaching, Classes and Camps is not intended to be a substitute for professional medical advice, diagnosis or treatment that can be provided by my minor child’s own physician, therapist, licensed dietitian or nutritionist, or any other licensed or registered mental or physical health care professional. I understand that Sacred Medley Intuitive Coaching, LLC is not acting in any capacity as a medical or mental health provider and she is not giving medical or psychological advice. I understand that she is not providing health care, medical or nutrition therapy services or attempting to diagnose any disease, condition or other physical or mental ailment of the human body during the course of the 1-1 Coaching, Classes and Camps. Rather, Sacred Medley Intuitive Coaching, LLC is serving as a facilitator, coach, mentor and guide to provide my minor child with education, information, and tools to supplement any medical advice or treatment my minor child is receiving from his/her own medical providers.

Disclosure of Allergies and Sensitivities. I understand that if my minor child is provided with meals, snacks, or is exposed to other products while at the 1-1 Coaching, Classes and Camps, I agree to disclose to Sacred Medley Intuitive Coaching, LLC in advance any known or suspected food sensitivities or other allergies. I agree to disclose any physical limitations that may impact my minor child’s breathing or movement or any other health or mental condition of my minor child that may be affected during the 1-1 Coaching, Classes and Camps. If I suspect that my minor child has a medical or mental health emergency, issue or concern, I agree to inform Sacred Medley Intuitive Coaching, LLC immediately.

I agree to complete the medical information requested in the form below. I understand that if no information is provided, it will be assumed that I have knowingly and deliberately waived my right to provide such information to Sacred Medley Intuitive Coaching, LLC and as such, she cannot be held liable in any way or at any time for information that was not disclosed below.

Seek Medical Advice. I agree to seek the advice of my minor child’s physician regarding any questions or concerns my minor child or I have about my child’s specific health situation, including but not limited to possible or actual pregnancy, known or suspected food sensitivities or allergies, dietary restrictions, or any medications my minor child is currently taking.  I understand that I am advised to speak with my minor child’s own physician or mental health provider before implementing any 1-1 Coaching, Classes and Camps, and I agree to not disregard or delay seeking professional medical advice for my minor child or stop taking any medications without speaking to my minor child’s own physician or mental health care provider.

Imminent Harm. At any time before or during the 1-1 Coaching, Classes and Camps, should I know or fear that my minor child may cause imminent harm to himself/herself, other participants, Sacred Medley Intuitive Coaching, LLC, or any other person, I understand and agree that I am immediately obligated to let Sacred Medley Intuitive Coaching, LLC know, and to remove my minor child from the situation in a peaceful and cooperative manner; otherwise, I consent that my minor child may be asked to not attend the 1-1 Coaching, Classes and Camps, leave the 1-1 Coaching, Classes and Camps, and/or have immediate physical or mental health care administered to avoid causing mental or physical harm to my minor child or others.

Authorization for Consent to First-Aid or Emergency Treatment of Minor Child. I understand that if my minor child needs medical care and I am not present with my child that medical care may be unnecessarily delayed. Therefore, I agree and give my formal consent to the application of first-aid or other medical or mental health services to be applied to my minor child if needed in connection with an emergency health problem or potentially harmful situation during the 1-1 Coaching, Classes and Camps, and I agree to hold Sacred Medley Intuitive Coaching, LLC harmless as a result of any such injury or damage my minor child may suffer due to the application of medical or mental health services or treatment. I also agree and consent that Sacred Medley Intuitive Coaching, LLC may contact my Emergency Contact and share detailed information about my minor child’s emergency situation.

Confidentiality. I understand that to foster a relationship of trust, communications between Sacred Medley Intuitive Coaching, LLC and the minor will be kept confidential. However, I understand that as a parent or legal guardian, Sacred Medley Intuitive Coaching, LLC may wish to voluntarily disclose to me general details about my child’s progress, or may be required by law to disclose certain information to me, pertaining to my child’s health, safety and wellness. I understand that I am encouraged and urged to discuss any questions or concerns that I have about issues of confidentiality with Jessica Amber Barnum and my minor child. Unless a parent or legal guardian is present and requests the recording of 1-1 Coaching, Classes and Camps, Sacred Medley Intuitive Coaching, LLC does not record any information from anyone under 18 years of age in compliance with COPPA (Children’s Online Privacy Protection Act) and the GDPR (General Data Protection Regulation of the EU).  

Limitation of Liability. I waive and release Sacred Medley Intuitive Coaching, LLC from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law or equity, which I have ever had, now have or may claim to have in the future against Sacred Medley Intuitive Coaching, LLC arising from my minor child’s past or future participation in, or otherwise with respect to, anything related to and including the 1-1 Coaching, Classes and Camps, including any transportation to, from and during the 1-1 Coaching, Classes and Camps, unless arising from the gross negligence of Sacred Medley Intuitive Coaching, LLC.

Release of Claims. In no event will Sacred Medley Intuitive Coaching, LLC be liable to me or to any person for any direct, indirect, special, incidental or consequential damages for any use of, non-use, or reliance on this 1-1 Coaching, Classes and Camps, its information, programs and/or services, including, without limitation, personal injuries, accidents, misapplication of information, or any other loss, malady, disease, difficulty, injury, or otherwise, to my minor child, even if I am advised of the possibility of such damages, difficulties, or injuries, whether caused by the fault of my minor child,  Sacred Medley Intuitive Coaching, LLC, other attendees or other third parties. I agree to pay for all damages to the facilities caused by any negligent, reckless, or willful action that my minor child may take.

I have read, understand, agree to and accept this statement from Sacred Medley Intuitive Coaching, LLC: "The information I share verbally or in written form is for educational and informational purposes only and is solely to be considered and used at your discretion for you and/or your child(ren) and/or animal. I am not providing medical, psychological, spiritual, philosophical or nutrition advice as a diagnosis or clinical recommendation.  Insights I may share in the intuitive coaching process are for you to discern if they resonate with you or not, and for you to determine what actions steps based on those insights you independently decide to implement in your life  or not. You should not use this information to diagnose or treat any health problems or illnesses without consulting your own medical practitioner (or veterinarian for your animals). Always seek the advice of your own medical practitioner and/or mental health provider (or veterinarian for your animals) about your specific health situation. To access all of my full disclaimer & agreement forms, see the footer on my website below."

As the parent or legal guardian of the minor child I hereby agree to all of the terms of this Consent & Release for Minors for, and on behalf of, my minor child named above. I hereby bind myself, the minor child, and all other assigns to the terms of this Consent & Release for Minors. I represent and certify that I have the legal capacity and the authority to act for, and on behalf of, the minor child in the execution of this Consent & Release for Minors. I understand that by completing and submitting the form below as my electronic signature, I consent to this Consent & Release for Minors,  and I voluntarily surrender certain legal rights on behalf of myself and my minor child.

I have also read, understand, agree to and accept the Client Agreement Form linked to the Sacred Medley Intuitive Coaching website  (please complete if you haven't done so already).

Emergency Contact Information: In case of an emergency, I authorize  Sacred Medley Intuitive Coaching, LLC to contact the person I list in the form below and to convey pertinent details related to the situation. That person can be contacted by phone (call or text) and email. 

By reading, completing and submitting the Consent & Release for Minors form below, I am stating that I have read, understand, agree to and accept the content described above. 
Sacred Medley Intuitive Coaching, LLC
jessica Amber Barnum
970-456-7241
jessica@sacredmedleyintuitivecoaching.com
sacredmedleyintuitivecoaching.com

Date: 5/4/21

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