Waiver & Consent — Royal Energy Alchemy

Section 1Client Identity

This information is used to identify your signed agreement. It will be stored securely alongside your waiver record.

Full legal name *

Date of birth *

Email address *

Phone number *

Section 2Nature of Services & Informed Consent

What Royal Energy Alchemy Is: Energy Alchemy is a complementary wellness practice. Sessions may include energetic scanning, chakra balancing, parasite and cord removal, transmutation, distance healing, pain relief support, stress reduction, and spiritual coaching.

What It Is Not: Royal Energy Alchemy LLC services are not medical treatment, psychological therapy, psychiatric care, legal advice, or a substitute for licensed professional care. Daron Royal is not a licensed physician, therapist, psychologist, or counselor.

Pennsylvania Law Notice: Under Pennsylvania law, energy healing and spiritual wellness practices are not regulated as licensed healthcare professions. Nothing in this agreement creates a healthcare provider-patient relationship. If you are experiencing a medical or psychiatric emergency, contact 911 or your licensed healthcare provider immediately.

I acknowledge that:

I am participating voluntarily and may withdraw consent at any time. *

Results are not guaranteed. Energy work affects each person differently. *

Energy healing is not a substitute for medical or mental health care. I will continue with any licensed professional care I am currently receiving. *

If I am experiencing a medical or psychiatric emergency, I will contact 911 or a licensed professional — not Daron Royal. *

Any referrals to therapists or other professionals are recommendations only and do not constitute a diagnosis. *

I am responsible for my own wellbeing during and after sessions, including staying hydrated and following any recommended aftercare. *

Section 3Distance Session Acknowledgement

Royal Energy Alchemy LLC offers sessions that are conducted remotely without the client being physically present. Distance sessions use energetic intention and connection and do not require physical proximity.

Sessions may also be booked on behalf of another person. When booking a distance session for someone else, the booking party holds the energetic intention. You do not need the subject's knowledge or physical presence — your consent and focused intention are sufficient to open the session.

I understand that sessions may be conducted remotely and acknowledge the nature of distance energy work as described above. *

Section 4Release of Liability & Waiver

In consideration of receiving services from Royal Energy Alchemy LLC, I hereby release, waive, and hold harmless Daron Royal and Royal Energy Alchemy LLC from any and all claims, demands, damages, losses, costs, and expenses arising from or related to the services provided, except in cases of gross negligence or willful misconduct.

I understand that energy work is complementary in nature and I am choosing to receive these services of my own free will. This waiver is binding on me, my heirs, legal representatives, and assigns. This agreement is governed by the laws of the Commonwealth of Pennsylvania.

I have read, understood, and agree to the Release of Liability above. *

Section 5Recording Consent (Required)

Royal Energy Alchemy LLC records sessions for documentation, treatment planning, AI-assisted note generation, quality assurance, and service delivery purposes. Recording is a required component of services provided by Royal Energy Alchemy LLC. If you do not consent to recording, please do not schedule services.

I understand that my session will be recorded and I consent to recording as a required condition of receiving services. * (Required)

Optional Media Release — check all that apply

Option A — Internal use only

AI-processed session notes, treatment plans, and internal documentation. Not shared publicly.

Option B — Educational content with identity protected

Face blurred, voice altered if applicable, no identifying information used.

Option C — Full release

My likeness and voice may appear in published educational or promotional content on Facebook, Instagram, YouTube, and TikTok.

If no option is selected, your recording will be used for internal documentation purposes only (Option A applies by default).

Section 6Privacy & Data Disclosure

Royal Energy Alchemy LLC may use de-identified, anonymized session data for aggregate research, service improvement, and pattern tracking. No identifying information will be published or shared without separate explicit consent. Full details are in the Privacy Policy.

I acknowledge that de-identified session data may be used for aggregate research and service improvement as described in the Privacy Policy. *

Section 7Cancellation & Payment Policy

Booking: Full payment is required at the time of scheduling to confirm your appointment. Appointments are not confirmed until payment is received.

Refund Policy:
· Cancellation 72+ hours before: 50% refund or one-time reschedule
· Cancellation within 72 hours: non-refundable
· Same-day cancellation: non-refundable
· No-show / no-call: non-refundable. Rebooking requires payment in full
· If Daron must cancel: full refund or reschedule, your choice

I have read and agree to the Cancellation & Payment Policy above. *

Section 8Electronic Signature & Final Acknowledgment

Your electronic signature is legally binding under the E-SIGN Act (15 U.S.C. § 7001) and the Pennsylvania Electronic Transactions Act (73 P.S. § 2260.101). It carries the same legal weight as a handwritten signature.

By signing, I confirm that:

I have read this entire document and understand its contents. *

I am 18 years of age or older, or a parent/guardian signing on behalf of a minor. *

I am signing freely and voluntarily, without pressure or coercion. *

I understand energy work is not a substitute for medical or mental health care. *

Your Signature *

Draw your signature above

Typing your name constitutes a legally binding electronic signature.

Printed name *

Today's date

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This form is submitted securely. A copy will be sent to royalenergyalchemy@gmail.com and to your email address.

Choose how to pay

For Venmo, Zelle, Cash App or PayPal, your time is held for 48 hours while you send the payment. Put your full name in the payment note so Daron can match it.

✦ Waiver Signed

Your consent agreement has been submitted to Royal Energy Alchemy LLC.

Your Client Reference Number

Save this for your records.

Next Step

Your waiver is complete. Continue to secure payment so Daron can finalize your appointment.

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Royal Energy Alchemy LLC · Erie, Pennsylvania