Public Healing Clinic Consent Form

DIVINE SPARK - HEALING CLINIC CONSENT FORM

I acknowledge that I have voluntarily agreed to receive spiritual communication within the Divine Spark Sanctuary, which is a service of Laura Hansen/GoldVision, LLC (referred to as “Divine Spark” in remainder of form).

I am voluntarily participating in this spiritual counseling and I accept complete responsibility for my own psychological, mental, emotional and spiritual well-being.

I, on behalf of myself and my assigns, heirs, executors, guardians and other legal representatives (heretofore referred to as “et al”), release, discharge, waive and forever relinquish Divine Spark (including Divine Spark’s volunteer practitioners, agents, and employees -- heretofore referred to as “et al”) from any and all claims, actions or causes on action whatsoever which may later arise, known or unknown, arising out of or in any way perceived to be connected with my participation or involvement in this spiritual counseling/healing including, but not limited to, any information provided to me or statements made during such spiritual counseling/healing.

Further, I agree that under no circumstances will I, or et al, prosecute or present any claims against, sue or seek to attach the property of Divine Spark, et al, and that I waive all actions, claims or demands that I now or hereafter may have, for any injuries suffered by me during my participation or involvement in the spiritual counseling resulting from any acts or omissions of Divine Spark, et al, or resulting from the acts or omissions of any other participant in the spiritual counseling/healing.

I, for myself, et al, hereby agree that in the event any claim for damages shall be prosecuted against Divine Spark, et al as a result of my acts or omissions, that I, or my estate, shall indemnify and save harmless Divine Spark, et al, from any and all claims or causes of action by whomever and wherever made or presented for damages, including the cost and expense of defending the same.

I have carefully read this Agreement and fully understand its contents, terms and significance and legal consequences of signing this Agreement. I am aware that this Agreement contains a release of liability and a contract between Divine Spark and myself and I sign this Agreement of my own free will.