WP E-Signature by Approve Me - Sign Documents Using WordPress -

Acutonics® Online: Student Agreement Form

By signing this form, I agree to abide by the Acutonics Institute of Integrative Medicine, LLC student requirements:

To behave in a professional and ethical manner,
To respect the privacy, dignity, and sensitivity of everyone in the class,
To engage in classroom discussion without disrupting the learning process,
To be respectful of the tools used in class recognizing that they are powerful healing tools,
To be respectful of the community that is created within the online class: arriving on time and notifying my instructor, if for any reason I am not able to honor my commitment to be in the video classroom as scheduled.

I understand and accept that this class:
has been adapted for on-line live video streaming and that the teacher may require viewing of pre-recorded modules or review and reading of course material prior to the class. If the course includes hands on practicum it will be demonstrated and explored from the approach of self-care or treating a family member. In the future (when travel restrictions are lifted) I acknowledge that I will be required to participate in in-person practicum events and clinic days.

I understand and agree that the course materials taught in this class are the exclusive intellectual property of the Acutonics Institute of Integrative Medicine, LLC. I agree not to alter, share, teach or distribute in any form whatsoever any materials I receive from my teacher or the Acutonics Institute unless I am authorized to do so in writing from the Acutonics Institute.

I acknowledge that I may state on my website, marketing materials, and social media platforms

which specific Acutonics Classes I have taken and how many hours of training I have completed.

I agree not to refer to myself as a Certified Acutonics^® Practitioner until I have successfully completed the Acutonics^®Certification Program.

I acknowledge that this work is deeply transformational. I agree to be present and mindful of the energetics of the group, within an online learning environment, and to keep confidential any personal information that is shared within the class.

I authorize my Teacher Theresa Lee Morris and/or the Acutonics Institute of Integrative Medicine to record the class and to share the audio portion of the class at their discretion with other students. I also authorize the use of my image and/or audio, visual, or written comments about the class for educational or promotional purposes.

I understand that it is my responsibility to inform the Teacher if there are any existing conditions for which I am currently seeking medical support, or that may limit my participation in the class.

I agree to be contacted by my instructor(s) or the Acutonics Institute by telephone, mail, or electronic mail to keep me informed about areas of interest relating to Acutonics.

PLEASE SIGN REVERSE SIDE

Name (please print):

Address: ____________________________________________________________________________

Phone(s): _____________________________ Email: ________________________________________

By signing below, I agree that I have read and understand everything written above. I assume full responsibility or my participation in class and understand that neither the Teacher(s) nor Acutonics can accommodate students unwilling or unable to meet these requirements.

Emergency Contact: Phone:

Leave this empty:

Your legal name

Your email address

Signed by Theresa Lee
Signed On: April 23, 2021

Timestamp

Audit

April 22, 2021 1:04 pm PDT

Acutonics® Online: Student Agreement Form Uploaded by Theresa Lee - account@ponnuki.net IP 209.52.44.123