I understand that this is a 12 week online Energetic Educational Course for my personal use only, from which I may experience a greater connection with my self organizing wisdom. Varied models of consciousness and models of spirituality will be presented and may be integrated into this course. I understand that this online experience is not a means of diagnosing or treating any condition, physically, emotionally, mentally, psychologically, or spiritually. I participate under my own volition and responsibility.

This online course will include various exercises that may include movement, breathing and other forms of internal re-education and awakening . Any of these types of experiences in and of themselves may awaken physical and emotional feelings or memories.

It is understood that sometimes during a transformational process it may feel wonderful, or ecstatic, and sometimes it does not feel comfortable at all. It is further understood that if any participant is currently in the care of a psychologist or therapist, that consent has been given by their practitioner to participate in this online course.

I understand that portions of the experience may be recorded through photo, video and/or audio and I agree to allow Donny Epstein, Epstein Technologies, LLC, EpiEnergetics Institute, LLC, and its agents to use photos/video/audio taken of me for educational, commercial, marketing, and public relations purposes. My signature grants permission to Donny Epstein, Epstein Technologies, LLC and EpiEnergetics Institute, LLC to use any of said reproductions in any responsible manner, including, but not limited to: publications, advertisements, educational materials, web sites, and/or commercial products.

I understand the information on this form and agree to participate in the 12 STAGES IN 12 WEEKS online course with the intent described above.