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Breathwork Waiver & Release of Liability

I have voluntarily enrolled in this Breathwork activity. I understand that I am under no obligation of any kind to participate in this Breathwork activity and I voluntarily enter this into this Waiver and Release of Liability.

I understand the Breathwork is a personal growth experience designed to enhance the quality of life, and is not a substitute for psychotherapy and does not substitute for therapy if needed, and does not prevent, cure or treat any mental disorder or medical disease. I understand that I am responsible for creating and implementing my own physical, mental and emotional wellbeing, decisions, choices, actions, and results. As such, I agree that the Breathwork facilitator(s) is not and will not be liable for any actions or inaction, or for any direct or indirect result of services provided by the Facilitator(s).  I understand that this Breathwork activity is not medically supervised and that both Destiny Wolf and Bess Wittingslow are neither licensed psychotherapists nor licensed medical professionals and that breathwork a not a substitute for any medical diagnosis or medical treatment.

I understand that this Breathwork activity will involve strong connected breathing and may include guided meditation. I understand that Breathwork can involve dramatic experiences accompanied by strong emotional and physical responses or releases.

I understand that I might find Breathwork physically, emotionally, and/or mentally stressful. I hereby affirm that I am in good health and able to participate in this activity. I do not have any physical or mental conditions which would impair my ability to engage in this activity or which would otherwise endanger my health during this Breathwork activity, or which would cause any risk of harm to myself or other participants.

I have hereby been advised that I should talk to my physician and/or psychotherapist if I had any questions about my physical or mental ability to safely participate in this preferred activity. If I have chosen not to obtain a physician's consent prior to my participation in Breathwork, I hereby agree that I am doing so solely at my own risk. I understand that is my sole responsibility to participate in activities that are appropriate for the current status of my health and to modify the Breathwork activity to accommodate my own needs or limitations. 

 

I agree that if there is any change in this representation, I will promptly advise the Facilitator(s). If I have any questions or concerns about whether or not a particular activity is appropriate to my current health status, I understand it is my responsibility to ask my doctor before I participate in such activity.

I agreed to indemnify and hold harmless Destiny Wolf, Bess Wittingslow, and their respective directors, officers, employees, agents, and beneficiaries from and against any and all claims and expenses, including attorney fees, arising out of my participation in this Breathwork activity.

In consideration of my participation in this Breathwork activity, I hereby waive and release Destiny Wolf and Bess Wittingslow and/or any assigns or beneficiaries from any and all claims, costs, liability, and expenses for any injury loss or damage whether known, anticipated, or unanticipated arising from my participation in Breathwork with Udaya Retreats, Destiny Wolf and Bess Wittingslow.

This Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I acknowledge that I have thoroughly read this Waiver and Release of Liability in its entirety and fully understand it.

By signing this document, I am waiving certain rights I and/or my successors might have to bring legal action or assert a claim against Destiny Wolf and Bess Wittingslow and/or any assigns or beneficiaries.

MEDICAL CONDITIONS

Participant certifies that he/she is not pregnant and does not have epilepsy, a detached retina, glaucoma, uncontrolled high blood pressure, cardiovascular disease and/or irregularities including but not limited to prior heart attack or heart arrhythmia; prior diagnosis by a Medical Professional of bipolar disorder or schizophrenia; strokes, TIAs, seizures or other brain/neurological condition or disease; family history of aneurysms; use of prescription blood thinners such as Coumadin; hospitalization for any psychiatric condition or emotional crisis within the last fifteen years; osteoporosis that is serious enough whereby intense movement could cause physical injury; recent physical injuries that are not fully healed and could be re-injured through intense movement; or any other medical or physical conditions which would impair or affect his/her ability to engage in any activities that involve physical and/or emotional release or which would cause any risk of harm to Participant, other participants and/or any participating Breathwork Facilitators and/or Apprentices or otherwise endanger Participant’s health while participating in a session organized by  Udaya Retreats.  If you have been diagnosed with PTSD and are currently in therapy, it is required that you get the approval of your therapist before participating.  Also, if you have asthma, please make sure to have your inhaler next to you when you breathe in case you need it.  If you have any doubt about whether you should participate, consult your physician or therapist as well as a Facilitator before attending. Participant also certifies that if he/she has asthma that he/she has brought and will have access to his/her inhaler during any sessions that Participant chooses to participate in.

Have you been hospitalized in the last 12 months?
Are you suffering from a medical condition, illness, or injury?

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