In the interest of fostering a safe and secure environment for all participants, Breathwork Evolution requires the completion of this Liability Waiver Form. It is essential to recognize that participation in breathing sessions may not be suitable for everyone, particularly individuals with specific medical or psychological conditions. By signing this waiver, you are acknowledging the risks and assuming responsibility for your participation.
Eligibility and Health Conditions:
Breathing sessions may not be suitable for individuals with the following conditions:
Abnormally high blood pressure
History of epilepsy and seizures
Use of heavy medication
Severe psychiatric symptoms, especially psychosis or paranoia
Recent surgical procedures
"Individuals diagnosed with asthma are advised to carry their prescribed inhalers and, prior to participation, to seek consultation with both their attending physician and the designated breathing session instructor. Furthermore, it is recommended that individuals currently grappling with emotional or spiritual crises, or those who contend with mental health conditions without ongoing treatment or sufficient support, exercise due caution before engaging in these sessions."
Please be aware that this list is not exhaustive, and if you have any questions or concerns about a medical or psychological condition that is not listed here, we strongly recommend consulting with both a physician and your Breathwork facilitator before participating in our breathing sessions.
I hereby affirm and warrant that I am in a state of sound physical, mental, psychological, and emotional health.
I further acknowledge and understand that my participation in the breathing sessions is contingent upon my maintenance of good health. I also acknowledge that I will be precluded from participating in the aforementioned sessions. This declaration and affirmation of my good health collectively form an essential agreement permitting my engagement in these sessions.
I also recognize and understand that the individual conducting these sessions is not a duly licensed medical doctor, psychiatrist, or specialized healthcare practitioner. I acknowledge that the activities presented during these sessions are not designed or intended to provide treatment or diagnostic services for specific medical conditions, whether they pertain to physical, psychological, or emotional health matters.
Assumption of Risks:
I voluntarily choose to participate in these activities with full knowledge of the potential risks and consequences, whether known or unknown. I assume all such consequences willingly.
Release of Liability:
I (Releaser) agree to release and forever discharge the trainer Tomi Massey (Breathwork Evolution) including the other party’s affiliates, helper, subordinate, subcontractor, successors, officers, employees, representatives, partners, agents, and anyone claiming through them, in their individual and/or corporate capacities from any and all claims, liabilities, obligations, promises, agreements, disputes, demands, damages, causes of action of any nature and kind, known or unknown, which the party has or ever had or may in the future have against the other party arising out of or participation in the above-mentioned activities.
I understand and agree to accept financial responsibility for any costs related to medical treatment or care that may arise from my participation in these sessions.
Videos and photographs waiver:
Participants hereby acknowledge and consent to the possibility of videos, photographs, and images being captured during the session. These videos, photographs, and images may be used for promotional, marketing, or informational purposes by Breathwork Evolution, without the need for further consent or compensation.
Yes, I (releaser) consent to the use of photos and videos taken during the session for promotional, marketing, or informational purposes by Breathwork Evolution.
No, I do not consent to the use of my photos or videos for promotional purposes.
Use of Bodywork or Physical Touch:
Yes, I consent to the instructor and/or helpers/facilitators using bodywork or physical touch during the session, as described in the provided explanation.
No, I do not consent to the use of bodywork or physical touch during the session.
I am 18 years of age or older, and I am competent to contract in my own name. I have read this liability, release, and release of media before signing below, and I fully understand the contents meaning, and impact of this release. I have voluntarily waived certain rights by signing this release of liability without any external influence.