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Waiver Form
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I agree to the Terms and Conditions
I understand that appointments cannot be canceled, but can be rescheduled if done more than 24 hours in advance and that there are no refunds offered.
I, Client confirm that I understand that Resonant Yoga and Coaching Healing Sessions, Events and Retreats are meant to help me align with myself to develop a satisfying relationship with my body, mind and fulfill my purpose. It does not involve the diagnosis or treatment of mental or physical disorders as defined by WHO: International Classification of Diseases, ICD-11 Chapter VI. Resonant Coaching, Yoga are Pavla’s offerings not to be used as a substitute for psychotherapy, psychoanalysis, mental health care, substance abuse treatment, or other professional advice by legal, medical, or other qualified professionals. It is mine, the Client's, exclusive responsibility to seek such independent professional guidance and advice as needed. As in the case of any physical or emotional activity, the risk of injury or serious disabling, is always present, and it can’t be entirely eliminated. I, the Client assume a full responsibility for any and all damages, which may incur through participation. If I, the Client, am currently under the care of a mental or physical health professional, it is a condition for Resonant Coaching and Yoga to happen that I, the Client, show the mental or physical health care provider this document. Pavla Haluskova is open to having a conversation about how Resonant Coaching and Yoga may or may not support me, the Client. I, the Client hereby agree to irrevocably release and waive any claim that I have now or hereafter may have against Pavla Haluskova. I have read, agree with, and will adhere to this information.
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Waiver Form
Name
First
Last
Phone Number
Email Address
Terms and Conditions
(Required)
I agree to the Terms and Conditions
I understand that appointments cannot be canceled, but can be rescheduled if done more than 24 hours in advance and that there are no refunds offered.
I, Client confirm that I understand that Resonant Yoga and Coaching Healing Sessions, Events and Retreats are meant to help me align with myself to develop a satisfying relationship with my body, mind and fulfill my purpose. It does not involve the diagnosis or treatment of mental or physical disorders as defined by WHO: International Classification of Diseases, ICD-11 Chapter VI. Resonant Coaching, Yoga are Pavla’s offerings not to be used as a substitute for psychotherapy, psychoanalysis, mental health care, substance abuse treatment, or other professional advice by legal, medical, or other qualified professionals. It is mine, the Client's, exclusive responsibility to seek such independent professional guidance and advice as needed. As in the case of any physical or emotional activity, the risk of injury or serious disabling, is always present, and it can’t be entirely eliminated. I, the Client assume a full responsibility for any and all damages, which may incur through participation. If I, the Client, am currently under the care of a mental or physical health professional, it is a condition for Resonant Coaching and Yoga to happen that I, the Client, show the mental or physical health care provider this document. Pavla Haluskova is open to having a conversation about how Resonant Coaching and Yoga may or may not support me, the Client. I, the Client hereby agree to irrevocably release and waive any claim that I have now or hereafter may have against Pavla Haluskova. I have read, agree with, and will adhere to this information.
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Resonant Restorative Yoga with Reike and the sound
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Weekend workshop to reclaim our body
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Journey to ourselves through hour Breath
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Book a Session
Name
First
Last
Cell Phone
Email Address
Date of Birth
Month
Day
Year
Emergency Contact Name
Phone and Relationships
Have you ever practiced yoga before? If so, what kind and for how long?
Please list any injuries, medical issues, and/or important medical history
Please list any injuries, medical issues, and/or important medical history
Anything else you would like me to know?
Terms and Conditions
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I agree to the Terms and Conditions
Platform: We will do our sessions in person or over zoom. If the connection is too unstable I will call you on phone, Facetime, Messenger or Whatsapp. You will receive a zoom link in your email after we set up our day to meet.
How many sessions: Everyone is looking for a different outcome than why they would like to practice so this will absolutely be your choice of what you think is a good amount for you. As a standart, I suggest three 75 minute sessions once a week for the first month, then two sessions for some month, and longer intervals as you gradually internalize the work we do. I suggest you commit yourself to a minimum of 3 months. If you have other ideas of how you want to work with me, I'm open to that too.
Booking: Upon our conversation we will find a day and time that works best with your schedule. I understand that life happens and it can surprise us from time to time. You can easily reschedule or give me a cancellation 24 hours notice ahead.
Contact: Feel free to contact me between our sessions if you have any questions, challenges, or something you would like to share or discuss. I enjoy knowing what goes on for you! Please keep it at 5-10 minutes each time. I strive to reply to email or text messages within 48 hours. This is free of charge.
Pricing: I charge $128 per 75 minute session. The payment must be received before or after our session unless we agreed on a different payment style, which will be added to this form. I offer a sliding scale for people in need, please reach out before our session to discuss if you are considering this possibility. I offer a 15% reduction if you pay for 10 sessions in advance. These packages must be used within one year of purchase.
Consent
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I agree
I, Client, recognize that activities related to yoga, retreats and/or trips include physical movement as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk or injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from Pavla Haluskova. I will continue to breathe smoothly. I assume full responsibility for any and all damages, which may incur through participation.
Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga. I hereby agree to irrevocably release and waive any claim that I have now or hereafter may have against Pavla Haluskova.
I have read, agree with, and will adhere to this information. (Please have a parent/ guardian sign if under 18 years old.)
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Yoga Sessions
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Private Yoga Sessions
10 Package Session for Private Yoga
Private Coaching Session
10 Packages Sessions for Private Coaching
Constellations for 60 Session
90 min Session
Sound Ceremony 60 min Private Session
60 min up small group sound ceremony session
90 min private sound ceremony session
90 min small group sound ceremony
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Yoga Form
Name
First
Last
Cell Phone
Email Address
Date of Birth
Month
Day
Year
Emergency Contact Name
Phone and Relationships
Have you ever practiced yoga before? If so, what kind and for how long?
Please list any injuries, medical issues, and/or important medical history
Please list any injuries, medical issues, and/or important medical history
Anything else you would like me to know?
Terms and Conditions
(Required)
I agree to the Terms and Conditions
Platform: We will do our sessions in person or over zoom. If the connection is too unstable I will call you on phone, Facetime, Messenger or Whatsapp. You will receive a zoom link in your email after we set up our day to meet.
How many sessions: Everyone is looking for a different outcome than why they would like to practice so this will absolutely be your choice of what you think is a good amount for you. As a standart, I suggest three 75 minute sessions once a week for the first month, then two sessions for some month, and longer intervals as you gradually internalize the work we do. I suggest you commit yourself to a minimum of 3 months. If you have other ideas of how you want to work with me, I'm open to that too.
Booking: Upon our conversation we will find a day and time that works best with your schedule. I understand that life happens and it can surprise us from time to time. You can easily reschedule or give me a cancellation 24 hours notice ahead.
Contact: Feel free to contact me between our sessions if you have any questions, challenges, or something you would like to share or discuss. I enjoy knowing what goes on for you! Please keep it at 5-10 minutes each time. I strive to reply to email or text messages within 48 hours. This is free of charge.
Pricing: I charge $128 per 75 minute session. The payment must be received before or after our session unless we agreed on a different payment style, which will be added to this form. I offer a sliding scale for people in need, please reach out before our session to discuss if you are considering this possibility. I offer a 15% reduction if you pay for 10 sessions in advance. These packages must be used within one year of purchase.
Consent
(Required)
I agree
I, Client, recognize that activities related to yoga, retreats and/or trips include physical movement as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk or injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from Pavla Haluskova. I will continue to breathe smoothly. I assume full responsibility for any and all damages, which may incur through participation.
Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga. I hereby agree to irrevocably release and waive any claim that I have now or hereafter may have against Pavla Haluskova.
I have read, agree with, and will adhere to this information. (Please have a parent/ guardian sign if under 18 years old.)
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Date
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Events with my early bird prices and after EB prices
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Private class session
10 package
Private sound healing
One private sound healing for couples
90 min sound healing
90 min sound healing for couples
Small Group sound healing ceremony in person
Large group
SUNDAY MARCH 19, 2023…. $45 after March 14th
Saturdays March 11 and 18th, 2023 … $33 after March 8th
Saturday, Sunday March 11-12, 2023 …$288 after March 6th
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Coaching Form
As we are embarking on a coaching journey together, or as you are considering so, I would like you to know what to expect and some beliefs and expectations I hold around this work; should something disturb you or awaken your curiosity, I welcome a conversation about it. Some of my core beliefs and commitments: • Safety: We might work with matters that are delicate for you. I am committed to providing safety for you, emotionally and in other ways. • Confidentiality: Your information is safe with me. Even the fact that we have conversations is confidential in my end. • Sensemaking: Your feelings make sense. Your actions make sense. I’m curious to understand you on your own terms and loyally accompany you through your issues. • Alignment: Wise and sustainable decisions are made from a state of alignment between body, soul, and mind as well as your past and present. I will support you to reach alignment before making decisions. • Connectedness: As humans, we form a web with each other and all living beings on this Earth; yet the predominant culture has taught us to stand strong on our own. I may remind you of your interconnectedness with those around you and everything else as we walk our walk. • Equity: I am committed to treat you and everybody else equally. As a white, European, middle class, middle-aged woman, I know I have blind spots. I am devoted to seeing myself and others more clearly and through the lens of human history, and I welcome being called into awareness when I’ve shown up with blindness. I am dedicated to supporting you as best I can during our coaching relationship. While working remotely, or in person we may identify your values, passions, and what your heart longs to express to get a sense of the seed in you that wants to grow. Or we may time-travel and release the fragments of you that are caught in the past. Or do roleplays to heal and gain understanding. Or through rituals, releasing the Unconscious Contracts or beliefs you may have. We will be following your agenda, not mine. Using a variety of approaches, we will discover what is alive for you and what your heart longs for, and develop a course of action accordingly even if this action may be non-action. If at any time you are uncomfortable with the direction of our coaching sessions or are not getting what you need from coaching I ignite your to let me know so that we may course-correct or end the coaching relationship. If any of what I have mentioned here causes questions or hesitation in you, please let me know. Client Information - Personal Profile Confidential - will be deleted when our caching relationship ends.
As we are embarking on a coaching journey together, or as you are considering so, I would like you to know what to expect and some beliefs and expectations I hold around this work; should something disturb you or awaken your curiosity, I welcome a conversation about it.
Some of my core beliefs and commitments:
• Safety: We might work with matters that are delicate for you. I am committed to providing safety for you, emotionally and in other ways.
• Confidentiality: Your information is safe with me. Even the fact that we have conversations is confidential in my end.
• Sensemaking: Your feelings make sense. Your actions make sense. I’m curious to understand you on your own terms and loyally accompany you through your issues.
• Alignment: Wise and sustainable decisions are made from a state of alignment between body, soul, and mind as well as your past and present. I will support you to reach alignment before making decisions.
• Connectedness: As humans, we form a web with each other and all living beings on this Earth; yet the predominant culture has taught us to stand strong on our own. I may remind you of your interconnectedness with those around you and everything else as we walk our walk.
• Equity: I am committed to treat you and everybody else equally. As a white, European, middle class, middle-aged woman, I know I have blind spots. I am devoted to seeing myself and others more clearly and through the lens of human history, and I welcome being called into awareness when I’ve shown up with blindness.
I am dedicated to supporting you as best I can during our coaching relationship. While working remotely, or in person we may identify your values, passions, and what your heart longs to express to get a sense of the seed in you that wants to grow. Or we may time-travel and release the fragments of you that are caught in the past. Or do roleplays to heal and gain understanding. Or through rituals, releasing the Unconscious Contracts or beliefs you may have.
We will be following your agenda, not mine. Using a variety of approaches, we will discover what is alive for you and what your heart longs for, and develop a course of action accordingly even if this action may be non-action. If at any time you are uncomfortable with the direction of our coaching sessions or are not getting what you need from coaching I ignite your to let me know so that we may course-correct or end the coaching relationship.
If any of what I have mentioned here causes questions or hesitation in you, please let me know.
Client Information - Personal Profile
Confidential - will be deleted when our caching relationship ends.
Name
First
Last
Phone Number
Email Address
(Are you on Messenger or WhatsApp with the above name and number? As a back-up if we needed
Hometown and Country
Closest Family
Date of Birth
Month
Day
Year
Have you ever been assigned a psychiatric diagnosis? If, which?
Anything else you would like me to know?
Terms and Conditions
(Required)
I agree to the Terms and Conditions
Platform: We do our coaching in private or over Zoom. If the connection cannot support a visual image, we will shut the video off. If Zoom is too unstable to accommodate us, I will call you on phone, Facetime, Messenger, or WhatsApp. You will receive an email from me with a zoom link.
How many sessions?As standart I suggest three 60 min conversations the first month, then 2sessions a month for some months, and longer intervals as you gradually internalize the work we do. I suggest you commit yourself to a minimum of 3 month Resonant Coaching.
If you have other ideas of how you want to work with me, I’m open to that too.
Booking: Upen our conversation we will find times and days that work best with your schedule. You can easily reschedule or give me a cancellation notice 24 hours ahead by letting me know via email or text.
Notes and Recordings: I will take notes during our sessions, if you would like to have them I can send you a picture of them. If you want a recording of our zoom session, zoom is set up to let you record. My notes are kept safely and only carry your first name and date on top.
Contact: Feel free to contact me between our sessions if you have questions, challenges, or something you would like to share or discuss. I enjoy knowing what goes on for you! Please keep it at 5-10 minutes each time. I strive to reply to email and text messages within 48 hours. This is free of charge.
Pricing: I charge $168 per hour. I offer a sliding scale upon our conversation, please reach out to me first to discuss if you are considering that offering. Each session needs to be paid in full amount before or after our session unless we agreed upon a different way of payment style which will be included in this release form. I offer a 15% reduction if you pay for 10 sessions in advance. These packages must be used within one year of purchase.
Consent
(Required)
I agree
I, Client confirm that I understand that Resonant Coaching is meant to help me align with myself to develop a satisfying relationship and fulfill my purpose. It does not involve the diagnosis or treatment of mental disorders as defined by WHO: International Classification of Diseases, ICD-11 Chapter VI. Resonant Coaching is not to be used as a substitute for psychotherapy, psychoanalysis, mental health care, substance abuse treatment, or other professional advice by legal, medical, or other qualified professionals. It is mine, the Client's, exclusive responsibility to seek such independent professional guidance and advice as needed. If I, the Client, am currently under the care of a mental health professional, it is a condition for Resonant Coaching to happen that I, the Client, show the mental health care provider this document. Pavla Haluskova is open to having a conversation about how Resonant Coaching may or may not support me, the Client.
Signature
(Required)
Reset signature
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Date
MM slash DD slash YYYY
Price for sessions/events
(Required)
Private session
10 Package
60 min Constellation
90 min Constellation
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