Bars Child Consent Form | Eloise Ansell

I (as named below) am the parent or legal guardian (optional)

First Name (required)

Last Name (required)

of Child's full name: (required)

Contact Info (for child's parent or guardian):

Address: (required)

Phone number: (optional)

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Phone number

Disclaimer: (optional)

Being the parent (or legal guardian) of the above child I understand the following:

1. understand that the Bars® session provided by Eloise Ansell is intended to enhance relaxation & by gently touching points on my head may help to release the electromagnetic charge of all thoughts, ideas, attitudes, decisions, and beliefs that I may hold.

2. acknowledge that Access Consciousness Bars is non-invasive & safe.

3. understand that participation in a session with Eloise is voluntary and that at any time I may choose to end my child's participation.

4. understand that so-called de-toxification symptoms or release during the 24-48 hours following the session may be experienced, particularly if you have been experiencing chronic or heightened levels of stress. understand that Bars sessions are not a substitute for medical treatment or medications.

5. am aware that Eloise Ansell does not diagnose nor does she prescribe medication.

6. am aware that any medical issues or concerns should be addressed with a qualified doctor.

7. Understand that information exchanged during any session is educational in nature and is intended to help me become more familiar and conscious of my own health status and is to be used at my own discretion.

8. agree to pay the agreed fee per session and I understand that a 24-hour cancellation notice is required to avoid a fee.

9. understand my email will be added to Eloise's mailing list and agree to receive emails. This includes ones of a marketing nature as well as up-to-date information regarding Eloise's services. Eloise will not share my information with 3rd parties & keep my data safe. I understand I can cancel this service at any time.

Eloise's full Data Protection Policy is available here.

Cancellation policy: (optional)

I understand that for a free cancellation for sessions, I will inform you (preferably by text/WhatsApp, or email if not) at least 24 hours prior to the appointment. I will be charged 50% of the usual price for canceling the appointment with less than 24 hours notice.

Confidentiality policy: (optional)

I understand that the information on this form and any information imparted during these sessions are strictly confidential in nature and will not be shared with anyone without my written permission. General information, excluding names, may be used to help others further understand the efficacy and use of any modalities Eloise teaches.

I read, understand and agree with the above disclaimer, cancellation & confidentiality policies. (optional)

Today's Date: (required)

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I agree that my name below will be as valid as a handwritten signature to the extent allowed by local law