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WELLNESS SESSIONS:

- Spiritual Counseling

- Life Coaching

- Energy Work

- Meditation

CLIENT AGREEMENT, INFORMED CONSENT, ASSUMPTION OF RISK, AND RELEASE OF LIABILITY


Nature of Services

I understand that I am voluntarily choosing to participate in a spiritually oriented personal-growth, coaching, meditation, energy-work, or related session or workshop offered by TONGASS TEAGUE LLC.

Depending on the session and my choices, these services may include reflection, conversation, guided practices, sitting or walking meditation, breath awareness, emotional exploration, spiritual inquiry, visualization, energy work, and light consensual physical contact.

I understand that I may decline, modify, pause, or stop any practice or activity at any time.

Practitioner Education and Experience

I understand that Teague Whalen is insured as a practitioner through the Energy Medicine Professional Association.

His education and experience include a bachelor’s degree in psychology; ordination as a minister through the Universal Life Church Monastery; Zen Buddhist practice since the early 2000s; teaching sitting meditation for multiple semesters at the University of Alaska Southeast; study with qigong and tai chi teacher Jeff Notz; facilitating a year-long qigong workshop in Ketchikan; and personal experience with guided meditation practices, including past-life regression and future-self progression.

I understand that this education and experience does not constitute licensure as a physician, psychologist, psychotherapist, psychiatrist, licensed professional counselor, clinical social worker, or other licensed healthcare or mental-health provider.

Scope of Practice and Professional Boundaries

I understand that these services are educational, experiential, spiritual, and personal-development services.

They are not medical care, psychotherapy, psychiatric treatment, crisis counseling, licensed professional counseling, diagnosis, or treatment of any physical or mental-health condition.

I understand that Teague Whalen and TONGASS TEAGUE LLC are not acting as my physician, psychologist, psychotherapist, psychiatrist, licensed mental-health counselor, or other licensed healthcare provider.

No particular result, healing outcome, spiritual experience, transformation, or improvement is promised or guaranteed.

I remain responsible for determining whether these services are appropriate for me and for seeking assistance from an appropriately licensed medical, psychological, psychiatric, or other healthcare professional when needed.

I understand that I should not discontinue or change prescribed medication, medical treatment, psychotherapy, psychiatric care, or other professional treatment based on anything occurring during a session without first consulting the appropriate licensed professional.

I understand that the practitioner may decline, pause, modify, or end a session if the practitioner believes that the requested service is outside the practitioner’s scope of practice, may not be appropriate for me, or may require assistance from a licensed healthcare or mental-health professional.

Possible Experiences and Assumption of Risk

I understand that personal-growth work, meditation, spiritual inquiry, emotional exploration, breath awareness, visualization, and energy-work practices may bring up unexpected physical, emotional, mental, or spiritual experiences.

These experiences may include, but are not limited to:

  • Emotional discomfort
  • Fatigue
  • Grief
  • Anxiety
  • Memories
  • Changes in mood
  • Temporary distress
  • Bodily sensations
  • Personal or spiritual insights
  • Unexpected emotional or psychological reactions

I understand that these experiences may occur during or after a session.

I knowingly and voluntarily assume the ordinary and reasonably foreseeable risks associated with participating in these services.

I agree to communicate any discomfort, concern, physical limitation, emotional distress, medical condition, mental-health concern, or other circumstance that may affect my ability to participate safely.

I understand that I am responsible for caring for my physical, emotional, and mental well-being during and after the session, including deciding whether to participate in, modify, pause, or stop any activity.

Mental-Health and Crisis Support

I understand that these services are not designed or offered as emergency care, crisis intervention, suicide prevention, or treatment for an acute psychiatric or psychological condition.

If I am experiencing an acute mental-health crisis, believe I may harm myself or another person, or require emergency psychological or medical assistance, I understand that I should contact 911, the 988 Suicide & Crisis Lifeline, another appropriate crisis service, or an appropriately licensed medical or mental-health professional.

I agree to inform the practitioner of any known condition, recent crisis, or circumstance that could materially affect my ability to participate safely.

I understand that the practitioner may decline, pause, or end a session and recommend that I obtain assistance from an appropriately licensed medical or mental-health professional.

Consent and Physical Boundaries

I understand that I control whether any physical contact occurs during a session.

Before engaging in physical contact, the practitioner will explain the general nature and purpose of the proposed contact and obtain my consent.

I may decline physical contact or withdraw my consent at any time, for any reason, without being required to explain my decision.

My consent to one form of contact, or consent given during one part of a session, does not constitute continuing consent to other contact or to contact during a later session.

I understand that I may also decline, pause, modify, or stop any meditation, visualization, breath-awareness exercise, emotional exploration, spiritual practice, or other activity at any time.

Confidentiality and Its Limits

TONGASS TEAGUE LLC will make reasonable efforts to protect the privacy of information I share during a session.

I understand, however, that these services are not psychotherapy, medical treatment, or licensed counseling and may not be protected by the same legal confidentiality or evidentiary privileges that apply to certain licensed healthcare relationships.

Information may be disclosed when reasonably necessary to:

  • Respond to an apparent medical or psychological emergency
  • Address a serious and imminent risk of harm to me or another person
  • Report suspected abuse or neglect when disclosure is required by law
  • Comply with a subpoena, court order, legal process, or other legal requirement
  • Defend against a complaint, insurance claim, or legal action
  • Communicate with the practitioner’s insurer, attorney, or professional adviser regarding a complaint or claim

Except as described above, the practitioner will not intentionally disclose information about my participation without my permission.

RELEASE OF LIABILITY FOR ORDINARY NEGLIGENCE

I UNDERSTAND THAT I AM GIVING UP CERTAIN LEGAL RIGHTS BY ACCEPTING THIS AGREEMENT.

To the fullest extent permitted by Alaska law, I release and discharge TONGASS TEAGUE LLC and its owners, members, employees, agents, and contractors from claims, demands, losses, costs, expenses, damages, liabilities, or causes of action arising from or related to my participation in the services described in this agreement, INCLUDING CLAIMS ARISING FROM THE ORDINARY NEGLIGENCE OF TONGASS TEAGUE LLC OR ITS OWNERS, MEMBERS, EMPLOYEES, AGENTS, OR CONTRACTORS.

This release does not apply to claims arising from gross negligence, reckless conduct, intentional misconduct, or any liability that cannot lawfully be released.

Emergency Medical Assistance

If an apparent medical or psychological emergency occurs and I am unable to provide instructions or consent, I authorize TONGASS TEAGUE LLC and its owners, employees, agents, and contractors to call 911 or obtain assistance from appropriately licensed emergency personnel.

I understand that TONGASS TEAGUE LLC does not undertake a duty to provide medical care, psychological treatment, transportation, or emergency services.

I remain financially responsible for emergency transportation, evaluation, treatment, and related expenses provided to me.

Payment and Cancellation Policy

Payment is due at the time of online booking unless another arrangement has been agreed to in writing.

A booked session may be canceled or rescheduled without a cancellation charge by providing at least 24 hours’ notice before the scheduled starting time.

Unless otherwise agreed in writing, a cancellation or request to reschedule made less than 24 hours before the scheduled starting time, or failure to attend the appointment, will result in a cancellation fee equal to 100 percent of the scheduled session fee.

The practitioner may waive or modify this policy in cases of emergency or other exceptional circumstances but is not required to do so.

If the practitioner cancels a session, the client may choose either a full refund or rescheduling without penalty.

Electronic and Remote Sessions

If I participate through telephone, video conference, or another electronic platform, I understand that remote sessions may involve risks including interruptions, technical failures, reduced privacy, unauthorized access, or limitations in the practitioner’s ability to respond to an emergency.

I am responsible for choosing a location that is reasonably private and physically safe for the session.

I agree not to participate in a session while driving, operating machinery, or engaging in another activity that requires my full attention.

No Recording Without Consent

I agree not to audio-record, video-record, photograph, livestream, or otherwise reproduce a private session without the prior consent of the practitioner.

The practitioner will not record a private session without my prior consent.

Governing Law and Venue

This agreement shall be governed by and construed under the laws of the State of Alaska, without regard to conflict-of-law principles.

To the extent permitted by law, any legal action arising from or related to this agreement or the services shall be brought in a court of competent jurisdiction located in Ketchikan, Alaska.

I consent to the personal jurisdiction and venue of those courts.

Entire Agreement

This agreement contains the entire understanding between me and TONGASS TEAGUE LLC concerning the services, risks, professional boundaries, payment terms, and release of liability addressed in this document.

Any amendment or exception must be made in writing and accepted by both parties.

Severability

If any provision of this agreement is found invalid or unenforceable, that provision shall be limited or removed only to the extent necessary.

The remaining provisions shall continue in full force and effect.

Participant Acknowledgment and Acceptance

By signing or electronically accepting this agreement, I acknowledge that:

  • I am at least 18 years old and legally capable of entering into this agreement.
  • I have read and understood the entire agreement.
  • I have had an opportunity to ask questions before accepting it.
  • I understand the nature and limitations of the services.
  • I understand the practitioner’s education, experience, scope of practice, and professional boundaries.
  • I understand the reasonably foreseeable experiences and risks described above.
  • I understand that these services are not medical care, psychotherapy, psychiatric treatment, licensed counseling, crisis intervention, diagnosis, or treatment.
  • I understand the payment and cancellation policies.
  • I understand that this agreement includes a release of claims arising from ordinary negligence.
  • I am accepting this agreement voluntarily and without coercion.
  • I understand that my electronic signature, checkbox acceptance, or other documented online acceptance may have the same effect as a handwritten signature.
  • I may receive or retain a copy of this agreement.

I Agree

August 25, 2026

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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