Be. Yoga Studio and Group Waiver
General Public and Waiver Programs Form
Please take a moment to read carefully and completely fill out this form and submit it online or you can print it out and bring it with you to your first session.
Please note: by typing your name or adding your signature and date below, you are eSigning this form, and acknowledging you understand and agree to the terms of this Be. Yoga Studio and Group Waiver Release of Liability.
Be. // A Center for Holistic Mental Health and Healing, LLC
New Client Consent | Participation & Release
A place to pause. A place to connect. A place to Be.
Welcome to Be.,
Our work is rooted in the belief that mental health and healing are whole-person experiences. Depending on your needs, services at Be. may include clinical mental-health care as well as complementary, supportive, educational, movement-based, and wellness experiences.
Because these offerings have different purposes and scopes, we want to be clear about what each service is—and what it is not.
Please read the following information carefully. By participating in services at Be., you acknowledge that you have had an opportunity to ask questions and understand the nature of the services in which you or your child are participating.
Our Approach to Care
At Be., we recognize that there is no single path to healing. Our approach may incorporate clinical mental-health care alongside complementary practices that support self-awareness, connection, regulation, movement, and overall well-being.
The specific services available to you will depend upon the practitioner, program, class, group, or offering in which you participate.
Clinical Mental-Health Services
When a service is identified as a clinical mental-health service and is provided by an appropriately licensed mental-health professional, that service may include assessment, diagnosis, psychotherapy, counseling, treatment planning, and/or treatment of mental-health conditions within the practitioner's professional scope of practice.
Your practitioner will communicate with you about the nature, purpose, and scope of clinical services provided to you.
Complementary, Alternative, Wellness, Educational & Supportive Services
Some services at Be. are designed to complement—not replace—clinical mental-health or medical care.
Unless specifically identified as a clinical mental-health service, the following offerings are intended to provide complementary, alternative, wellness, educational, experiential, or supportive experiences:
Therapeutic yoga and yoga-based wellness practices
Somatic awareness and body-awareness practices
Movement and movement-based wellness practices
Mindfulness, meditation, grounding, and relaxation practices
Breathwork and breathing practices
Aerial yoga and aerial movement
Wellness and educational classes
Psychoeducational groups
Reiki and Sound Services
Supportive and peer-oriented groups
Experiential and process-oriented groups that are not identified as psychotherapy
Workshops, retreats, and educational programs
Other complementary or alternative wellness practices offered by Be.
These offerings may support relaxation, self-awareness, emotional regulation, stress management, body awareness, personal growth, connection, and an individual's overall health and healing process.
These services are not represented as diagnosing, treating, curing, or preventing a mental-health disorder, medical condition, or other disease unless specifically identified and provided as a clinical service by an appropriately licensed professional.
Complementary and supportive services are not intended to replace psychotherapy, psychiatric care, medical care, or other professional treatment when such care is needed.
If your practitioner believes that additional or different support may be beneficial, they may encourage you to speak with an appropriate healthcare or mental-health professional.
Participation & Personal Responsibility
Your participation at Be. is voluntary.
We encourage you to remain an active participant in your own care by communicating openly with your practitioner, instructor, or group facilitator about your needs, concerns, limitations, and experiences.
You may choose not to participate in an activity or may discontinue participation when you feel that an activity is not appropriate for you.
You are responsible for providing accurate information regarding relevant physical health concerns, medical conditions, injuries, allergies, medications, pregnancy, physical limitations, or other circumstances that may affect your participation.
For children and adolescents, parents or legal guardians are responsible for providing accurate and complete information that may affect the child's ability to safely participate.
Movement, Yoga, Aerial & Somatic Participation
Some offerings at Be. involve physical movement, stretching, balance, changes in body position, suspension, or other forms of physical activity.
These activities may involve inherent risks, including but not limited to:
Muscle soreness, strain, sprain, or other physical injury
Falls or loss of balance
Injury associated with aerial equipment or suspension
Aggravation of an existing condition or injury
Dizziness, nausea, fatigue, or other physical reactions
Emotional discomfort or distress
Activation of difficult emotions, memories, or experiences
Other risks associated with physical or experiential participation
I understand that no physical activity can be guaranteed to be completely free of risk.
I agree to follow reasonable safety instructions and to communicate with my practitioner or instructor if I experience pain, discomfort, dizziness, emotional distress, or another concern that may make continued participation unsafe or inappropriate.
I understand that I may consult with my physician or another qualified healthcare professional before participating in physically demanding activities.
Food, Beverages, Essential Oils & Other Materials
Certain classes, workshops, or events may incorporate food, beverages, essential oils, topical products, herbs, or other materials.
I understand that individual reactions to these materials may vary.
I agree to communicate known allergies, sensitivities, dietary restrictions, or other relevant concerns before participating in an activity involving food, beverages, essential oils, or other materials.
I understand that I may decline to ingest, apply, or otherwise use any material offered during a class, workshop, or event.
I understand that possible reactions may include, but are not limited to, allergic reactions, skin irritation, burns, choking, or other physical responses.
Assumption of Risk & Release
I understand that participation in services and activities at Be. may involve inherent risks.
To the extent permitted by applicable law, I voluntarily assume the risks associated with my participation, or my child's participation, in services and activities offered by Be.
To the extent permitted by applicable law, I release and hold harmless Be. // Center for Holistic Mental Health and Healing, LLC; Be. // Child and Adolescent Mental Health, LLC; Carey Sorenson; and their respective owners, practitioners, employees, independent contractors, instructors, agents, and affiliates from claims arising from my or my child's participation in activities offered by Be., except where such a release is prohibited by applicable law.
This release is intended to apply to claims involving personal injury, property damage or loss, and other claims arising from participation in Be. activities, to the extent permitted by applicable law.
I understand that this section is a legal release and that I may seek independent legal advice before agreeing to it.
Personal Belongings
I understand that I am responsible for my personal belongings while attending Be.
To the extent permitted by applicable law, Be. is not responsible for loss, theft, or damage to personal property brought onto the premises.
Collaboration & Whole-Person Care
Healing is often supported by connection and collaboration.
When appropriate, practitioners within Be. may communicate with one another regarding a client's care or participation in services. Collaboration may support continuity, coordination, professional consultation, mutual treatment goals, and an integrated approach to care.
Information shared between practitioners may include information relevant to the services being provided, such as treatment goals, progress, relevant history, clinical impressions, or other information maintained within the client's record.
Be. may maintain client information electronically through its electronic health record system.
I understand that applicable privacy laws may permit certain information to be shared for purposes such as treatment, payment, and health-care operations, while other disclosures may require a separate written authorization.
I understand that psychotherapy notes maintained separately from a medical record may be subject to additional privacy protections.
Nothing in this form is intended to authorize a disclosure that requires a separate authorization under applicable law.
When a separate authorization is required, Be. will use an appropriate authorization identifying the information to be disclosed, the recipient, the purpose of the disclosure, and other information required by applicable law.
Group Experiences & Confidentiality
Some groups at Be. are intentionally designed as open groups, meaning that new participants may join and existing participants may discontinue participation over time.
Because of this format, group membership may change from one meeting to another.
Groups may provide a meaningful space to explore experiences, emotions, relationships, personal growth, and other aspects of life. Because participants may share personal or sensitive information, we ask everyone to help protect the integrity and safety of the group.
Participants are expected to:
Respect the privacy of other group members.
Keep personal information shared by other participants confidential.
Avoid discussing another participant's personal information outside of the group.
Not record, photograph, screenshot, livestream, or otherwise reproduce group sessions without express permission.
Be thoughtful about the personal information they choose to share.
Be. cannot guarantee that another participant will maintain confidentiality.
Confidentiality within a group is therefore a shared responsibility. Be. will establish and reinforce appropriate confidentiality expectations, but cannot control what another participant does outside of the group.
By participating in a group, I understand and accept this limitation.
Privacy & Limits of Confidentiality
Be. takes privacy seriously and makes reasonable efforts to protect the confidentiality of client information.
At the same time, confidentiality has legal and ethical limits.
Depending upon the circumstances and applicable law, a practitioner may be required or permitted to disclose information in situations involving suspected abuse or neglect, serious and imminent threats to health or safety, court orders, or other circumstances required or permitted by law.
Additional information regarding privacy and protected health information is provided through Be.'s applicable privacy policies and Notice of Privacy Practices.
Emergency & Higher-Level Care
Be. services are not intended to replace emergency medical or mental-health care.
If you or your child are experiencing an emergency, an immediate safety concern, or a situation requiring a level of care beyond the services being provided at Be., seek appropriate emergency or medical care.
Be. practitioners may recommend consultation with or referral to another healthcare or mental-health professional when additional support, assessment, or treatment is indicated.
Understanding & Acknowledgment
By participating in services at Be., I acknowledge that I have read and understand this document.
I understand:
The distinction between clinical mental-health services and complementary, alternative, wellness, educational, and supportive services offered by Be.
That clinical mental-health services may include diagnosis and/or treatment when provided by an appropriately licensed professional within their scope of practice.
That Be.'s complementary, alternative, wellness, educational, and supportive services are not represented as diagnosing, treating, curing, or preventing a mental-health disorder, medical condition, or other disease unless specifically identified as a clinical service.
That participation in yoga, aerial, movement, somatic, and other physically oriented activities involves inherent risks.
That I am responsible for communicating relevant medical, physical, or other limitations that may affect participation.
That I may decline or discontinue participation in an activity.
That group confidentiality is a shared responsibility and cannot be guaranteed by Be.
That privacy and confidentiality have legal and ethical limits.
That certain disclosures of health information may require a separate written authorization.
That I have had an opportunity to ask questions about the services and information contained in this document.
That I understand the nature and scope of the services in which I or my child participate.
By choosing to participate in services at Be., I affirm that I have read, understood, and agree to the terms outlined above.
Be. // Center for Holistic Mental Health and Healing, LLC
Come as you are. Be where you are. Begin from there.