Release form for frequency treatment

[Russell Shipp]

Close. Let me touch it up .

Release Form for Rife Frequency Treatment – Revision 2

( note: recent additions/changes are shown in red)

I, _________________________ fully acknowledge the implications of the following six (6) paragraphs listed below; further, I fully understand, acknowledge, and accept the potential consequences either expressed or implied by these statements below.

1. I have received a “Rife-type” of device, Model # ___________________ (hereinafter referred to as “device”) on temporary loan, for a maximum period of _______ weeks, from ________________________ on the date ___________through _________. Further, while in my possession, I am responsible for the safe-keeping of this device.

2. I have been trained in the specific procedures that are to be used in connection with the safe operation of this device, and I have been trained in specific safety precautions that are to be followed, before, during and after the use of this device.

3. While in my possession, this device is to be used on an experimental basis by me only, and for the expressed experimental purpose of alleviating symptoms from and or causes of my own ailment(s), which I characterize as follows: ________________________________, __________________________, and _________________________________. (To All: Does this second portion of Paragraph # 3 sound OK to leave in, or should we delete any reference in this Release Form to "treatment of ailments"?)

4. Use of this device is for experimental purposes only; however, I realize that in the process of using this device, I may experience some possible physiological changes.

5. Though the maximum duration in my possession is specified in Paragraph # 1 as two (2) weeks, the device owner may request the return of this device after three (3) days.

6. The device owner is receiving no compensation of any kind for allowing me to borrow this device.

Signed below by the Owner and the Temporary User of this Device:


_______________________________________
Temporary User of Device Date

_______________________________________
Owner of This Device Date


Question to Forum Members: Does anyone have additional suggestions/ changes? Or is there another “template” other than this draft above that will suffice?
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5 and 6 could be whited out and or tweaked on this basis something could be loaned out and done up real nice..... Does anyone know if the carpenters grace has a release form they could share as a sample or template maybe? Compensation is an issue I leave up to anyone.. but yeah it is fine as it stands too in the quote.. I think that is a version I might start using Sans number 5 since two weeks is not the nomral amount of time it Takes for me tp heal up a sick person.... My clients tend to take 6 to 8 weeks to recover. Then again I tend to aim for the tougher ones...That is great up there... Who can improvwe upon it still further