Forms

Please complete the online Membership form and the Liability Waiver and Release Form below prior to booking your first appointment. These are Required Forms.

Please arrive at least 20 minutes early for your first appointment to meet staff and sign in.

Private Membership Form

Free
Required for all bookings. Only need to complete one time.

Private Membership Terms and Conditions

PRIVATE LICENSE, INFORMED CONSENT AND RELEASE

Required for first appointment only. Please complete on-line form below, check box that you are in agreement and sign prior to your first appointment.

Full Name*

Email*

The undersigned hereby grants a Private License to the Minister Practitioner Darren Starwynn or his associates to engage in spiritual, mental, bioenergetic and/or nutritional modalities with the undersigned.
The undersigned acknowledges that the Practitioner does not diagnose or prescribe for medical or psychological conditions nor claim to prevent, mitigate or cure such conditions. The Practitioner does not provide diagnosis, care, treatment or rehabilitation of individuals, nor does the Practitioner apply medical, mental health or human development principles, but ministers to the suffering by prayer, spiritual, religious or mental means, without the use of any drug material remedy or physical manipulation and provides Ministerial Counseling under the seal of confidentiality. I understand that energy healing provided by Reverend Darren or his associates can complement any medical or psychological care I may be receiving.
The undersigned give Informed Consent to the services that will be provided. I take personal responsibility for my well-being and with respect for myself I gratefully accept control of my choices. My heirs, guardians, legal representatives, and I hereby and forever release, waive, and discharge any claims against Darren Starwynn and Lightworker Ministry, and all its local units, auxiliaries, affiliated organizations, ministers and agents) arising from the use or misuse of spiritual, mental, bioenergetic and/or nutritional modalities, indemnifying and holding the Practitioner harmless from all claims and liabilities there from, whatsoever.
The Practitioner reserves all rights.
I have read and agree to the terms above

Submit

Energy Healing Room

Forms

Private Membership Form

PRIVATE LICENSE, INFORMED CONSENT AND RELEASE