Energetic Assistance Program


We are now offering an amazing opportunity for individuals who truly need help. Our program allows individuals to apply for consideration to have FREE ASSISTANCE. Simply fill out this application and, if you are selected, you will be contacted by a member of the Emmie Evolving Team to discuss details.

 


Name *
Name
Date of Birth *
Date of Birth
FREE membership of this Facebook group is required to be considered. If you are not yet a member, simply join the group to qualify for this program.
When did you receive your last energy session?
When did you receive your last energy session?
When did this circumstance first begin? *
When did this circumstance first begin?
Do you feel when others perform energetic practices on you?
Statement of Consent *
I, the undersigned, understand that a bio-spiritual energetic session is not a substitute for medical or psychological diagnosis or treatment. Peaceful Warrior Project LLC (PWP), Emmie Evolving and its assigns do not diagnose conditions, prescribe or perform medical treatment, or interfere with the treatment of a licensed medical professional. It is recommended that I see a licensed physician, or licensed health care professional for any physical or psychological ailment I have. If I am uncomfortable in any way during my session I will inform my practitioner and/or request that the session be terminated. I agree and acknowledge that it is my duty to inform the practitioner in the event that I do not want to continue my participation in the session. If I experience any pain or discomfort during the session, I will immediately inform my practitioner so that the energetic work may be adjusted to my level of comfort. I affirm that I have stated all known medical conditions and answered all questions honestly. I agree and understand that there shall be no liability on the practitioner's part and the responsibility for decision to engage involvement with Emmie Evolving, PWP teachings, techniques, sessions or technologies rests with each individual, and thus the responsibility for any affects or effect that may or may not occur in conjunction with use of PWP teachings, techniques and technologies must also rest with the individual. As stated, in choosing to utilize PWP teachings, techniques, sessions, or technologies it is understood that in doing so the individual accepts full responsibility for any and all condition that may or may not occur in conjunction with such practice. It is further recognized that the individual, throughout the act of utilizing PWP teachings, techniques, sessions or technologies, thereby through this act agrees to release The Peaceful Warrior Project, LLC, all authorized PWP Bio-Spiritual Healing Program Teachers and facilitators, authorized PWP translators/authors, teachers, promoters and any individuals and organizations thereto related including Emmie Evolving, from any and all claims of liability or damages perceived or assumed to occur in conjunction with involvement in PWP teachings, techniques, sessions or technologies. If one is uncomfortable or in disagreement with this stated Notice of Implied Agreement and Consent to Terms and Conditions of Liability Release, it is suggest and recommended that one choose at this time non-involvement with said teachings, techniques and technologies, until a future time wherein such concerns have been assuaged.
Minor's name
Minor's name
Parent/Legal Guardian
Parent/Legal Guardian
Consent of Treatment for Minor *
By my signature below, I hereby authorize Peaceful Warrior Project LLC, Emmie Evolving and its assigns to administer bio-spiritual energetic techniques to my child or dependent as they deem necessary.
I acknowledge this service is not a replacement for medical treatment and agree to seek medical advise/treatment from my primary care physician at my discretion. I agree to the terms and conditions. *
Terms of Submission *
SUBMISSION OF THIS APPLICATION DOES NOT GUARANTEE FREE SERVICES WILL BE PROVIDED. APPLICANTS WHO ARE SELECTED WILL BE CONTACTED DIRECTLY BY A MEMBER OF THE EMMIE EVOLVING TEAM.