Creating a Certification Program in a health care discipline poses certain risks to the sponsoring organization. A way of minimizing these risks is to establish a clear agreement on the nature of the relationship and the legal framework within which the health care discipline is practiced. Please bear with us in wading through and understanding the legal language in this document, which is relatively long and probably the most bureaucratic experience you will have in your entire training. The framework is nonetheless important to understand.
This agreement is designed to establish a clear and legally binding understanding between you (the student whose name is printed and signed below) and "Innersource" (Innersource Unlimited, Incorporated, the Oregon corporation that offers the Eden Energy Medicine Certification Program).
By participating in the Innersource Eden Energy Medicine Certification Program (the "Program") you will receive instruction that includes informational material and techniques and, if you meet all applicable requirements, a certificate affirming that you have completed the Program; in turn, Innersource asks you to make certain legally binding commitments. By signing this document, you attest that you understand and agree to the following:
Informed Consent to Receive Eden Energy Medicine Instruction
ou will study Eden Energy Medicine [EEM] theory and methods and participate in delivering and receiving EEM methods, as part of your instruction during the Program.
EEM assesses disturbances in the body's energies and energy fields, and it offers to help facilitate a balanced and harmonious state in those energies. EEM includes use of energy testing, adapted and modified from the field known as applied kinesiology. EEM also includes the use of touch, along with movement of the practitioner's hands, to balance and harmonize the person's energies, as well as suggestions concerning specific postures and movements for achieving or restoring energy balance and harmony.
EEM does not purport to diagnose or treat disease and does not substitute for diagnosis or treatment from a qualified health practitioner for illnesses, injuries, or other medical conditions. Neither Innersource nor any of its instructors or practitioners among its staff offer diagnosis or treatment of any disease or health condition or are purporting to act as a physician to you as a student of the Program or to any of your clients. Any discussion of health conditions is incidental to the healing of energetic imbalances and should not be misinterpreted as a form of diagnosis or treatment. No EEM instructor or practitioner, no student, and no graduate of the Program, shall (unless licensed as a medical doctor or other health care professional authorized to provide medical care consistent with his or her scope of practice) render medical care, make recommendations involving pharmaceutical drugs or surgery, or handle medical emergencies.
You understand that it is your full responsibility to seek medical advice and opinion from your primary care physician (or other qualified health care provider as appropriate) regarding regular assessment and routine monitoring of your medical health or if you have symptoms that are distressing. You also must take responsibility to ensure that your study and use of EEM does not cause a delay in, or discourage appropriate medical diagnosis of and care for any medical condition you may have or that your clients may have. You acknowledge that the care of mental health symptoms and conditions requires appropriately trained health care professionals such as licensed psychologists, and that EEM does not purport to substitute for such care.
Neither Innersource nor current medical science are able to predict results with respect to use of EEM. Innersource makes no claims regarding the safety or efficacy of EEM and offers no guarantee of any particular result or any specific outcomes from use of EEM. Although the National Center for Complementary and Alternative Medicine at the National Institutes of Health has initiated a research program to study energy medicine, and while there is limited published data regarding energy healing generally, no published scientific research has offered significant data concerning the safety, efficacy, or mechanism of EEM. Thus, while some individuals may experience immediate benefits and some may experience short-term healing crises (that may include uncomfortable shifts in mood or psychological state, such as distressing feelings, images, thoughts and behaviors, which may persist or resurface at a later time), the risks and benefits of EEM have not been scientifically established.
No state licenses practitioners specifically for the practice of EEM, and Innersource makes no representation concerning the legality of practice of EEM in any state. Receipt of a certificate or other document either during or upon successful completion of the Program is no guarantee that the student can legally practice any of the techniques learned during the Program.
With an understanding of the above information, you make a voluntary, knowing, and intelligent decision with respect to participation in the Program, including receipt of EEM procedures and the touch involved therein. Your consent to such participation and receipt of EEM is given voluntarily, and you attest that you are competent and able to understand the nature and consequences of this decision.
You are strongly advised to seek legal counsel and appropriate insurance for the practice of EEM. You agree that upon successful completion of the Program, you will abide by all relevant legal rules (including relevant licensure statutes and regulations, and any applicable rules regarding insurance and financial transactions) and ethical rules applicable to your practice, and also continue to abide by all ethical codes and practice policies currently in force within the Program. The foregoing includes a specific commitment to give your clients an informed consent form that provides the information clients need to know about EEM, including a statement that EEM does not substitute for diagnosis or treatment from a licensed and qualified health practitioner for disease or other health conditions.
You agree to be bound by Innersource policies in effect, and modified from time to time, concerning the Program. These policies include but are not limited to the following:
Innersource, in its sole discretion as it deems appropriate, reserves the right to: (1) prevent anyone from attending one or more classes, (2) require anyone to leave a class, (3) prohibit anyone from attending further classes, (4) prohibit anyone from receiving a certificate of completion of the Program; (5) refunding only the prorated portion of the tuition associated with such class or classes not attended; or (6) remove, for cause, a certified graduate of the Program from any referral lists published or disseminated in any form by Innersource.
You understand that some classes are recorded and photographed, and that Innersource may distribute these images for educational and promotional purposes, and you give permission for your participation to appear (without any compensation) on these recordings and photographs.
You agree to keep the personal experiences of students and staff in the Program confidential and private unless you have their explicit permission to share their information. Innersource may, if subpoenaed or otherwise legally obligated or reasonably allowed or expected to do so (including circumstances where there is clear and imminent danger to yourself or another person), release information regarding your participation in our programs.
The handouts used in our Certification Program, including in the Level 1: Fundamentals Year, are designed as supplements to hands-on training. They are not meant to stand alone. Therefore, you agree not to present them, or derivatives of them, except in an authorized format as permitted by Innersource.
Assumption of Risk and Release of Liability/Indemnification.
You knowingly, voluntarily, and intelligently assume all risks involved in participating in the Program and the practice of EEM.
You also understand that any activity in which a person might participate involves some risk. In consideration of being permitted to enroll for the instructional and other services offered through Innersource, you release and hold Innersource, its agents, officers, employees, directors, successors, and affiliated corporations harmless, unless gross negligence can be demonstrated, from any claims arising out of your participation in the instructional or other services offered by Innersource or the use of facilities and/or equipment it provides.
Choice of Law and Jurisdiction; Severability; Entire Agreement
This form will be interpreted under Oregon law, and Oregon will be the forum for any lawsuits filed under or incident to this form.
If any portion of this form is held invalid, the rest of the document will continue in full force and effect.
This Agreement constitutes the entire agreement of the parties and supersedes all prior communications, understandings, and agreements relating to the subject matter hereof, whether oral or written.
IN WITNESS WHEREOF, the parties have caused their duly authorized representatives to execute and deliver this Agreement as of the date on the form.