Breathwork Liability Waiver & Release Form

 

TERMS AND CONDITIONS

 

1. The parties agree to the following terms and conditions:

a. Client is engaging in breathwork services to be provided by Georgina Crickmere of One Yoga Wellness and affiliates, contractors and/or employees/ volunteers

b. Client agrees to sign this Informed Consent and Assumption of Risk and Release of Liability.

c. This session is not recommended and is not safe under certain medical conditions. I, that client agree to inform all staff, including Georgina Crickmere of One Yoga Wellness and affiliates, contractors and/or employees/ volunteers, of any medications I am currently taking, and medical conditions or physical limitations I have prior to the event. I will disclose any and all conditions, medical or otherwise, that may affect my ability to participate in this breathwork session. This includes present or near past experiences of experiencing severe mental illness, neurological conditions, heart conditions, history of blood clots, currently experiencing spiritual emergence/crisis, epilepsy and seizures, detached retina and other ocular issues, heart conditions/attacks, high blood pressure, pregnancy, recent physical injuries, fractures and surgeries. I confirm that I am not pregnant, nor do I have severe asthma, heart disease, diabetes, a mental illness, epilepsy/history of seizures and/or acute physical injures or any other contraindications of breathwork. In the case of any of these conditions I understand participation will be revoked and I will not be allowed to participate in the session as a precaution to my health and wellbeing.

d. I understand that the facilitator of this session including their affiliates, contractors and/or employees/ volunteers, do not diagnose illness or disease and this session does not prescribe or replace medical treatment or pharmaceuticals.

e. As is the case with any physical activity, the risk of injury, is always and cannot be entirely eliminated. If I experience any unusual pain or discomfort, I will listen to my body and discontinue the activity, and clearly communicate this to the facilitator and ask for support from the facilitator. I assume full responsibility for any and all damages, which may incur through participation in this session.

f. I understand that this breathwork session is not a substitute for medical care and it is recommended that I continue to work with my primary health care provider for any condition that I may have.

g. I understand taking alcohol or drugs prior to, or during this session will result in me not being able to participate in the session. I agree that I will not be under the influence of drugs or alcohol whilst attending this session.

h. I confirm that I, alone, am responsible for deciding whether to participate in the breathwork session and that I participate fully at my own risk.

i. I understand that this session includes breathwork and trauma release which is made up of physical movement, breathing, meditation, release of emotions, touch, body work and music. I understand that each of these will be included in the session.

 

2. INFORMED CONSENT AND ASSUMPTION OF RISK AND RELEASE OF LIABILITY  This Informed Consent and Assumption of Risk and Release of Liability is material to the event Contract and is incorporated herein by reference.

 

I, the client certify that I am of adequate physical condition to participate in physical exercise. I certify that I am aware of the nature of this event and assume the full risk of participating in this event. I certify that I will disclose to Georgina Crickmere of One Yoga Wellness and affiliates, contractors and/or employees/ volunteers whenever suggested activities cause distress beyond my threshold. I certify that I will not hold Georgina Crickmere of One Yoga Wellness and affiliates, contractors and/or employees/ volunteers liable for any physical injury, whether minor, severe, or otherwise that may result from this event and breathwork facilitated by Georgina Crickmere of One Yoga Wellness and affiliates, contractors and/or employees/ volunteers. I certify that I assumes all responsibility for my participation in the breathwork session.

 

I consent that I am in good physical health and of sound mind, and do not suffer from any condition that would hinder my participation in any activity by Georgina Crickmere of One Yoga Wellness. These Activities include, but are not limited to, physical movement, breath, meditation, release of emotions, touch, bodywork and music. I understand that my participation in all offerings held by Georgina Crickmere of One Yoga Wellness and affiliates, contractors and/or employees/ volunteers are strictly for entertainment purposes and understand any personal medical concerns are under the care of a medical professional. Any advice given is ultimately determined by my own free will and I release any liability to sue Georgina Crickmere of One Yoga Wellness and affiliates, contractors and/or employees/ volunteers. My participation in all activities, is confirmation that I am fully responsible for any and all risks, injuries or damages known or unknown without limitation. Additionally I am aware that Georgina Crickmere of One Yoga Wellness and the location of the event is not a storage facility, if I leave items at the space after the event and do not contact them to pick up with 7 days they will be donated.

 

3. PHOTOGRAPHY, IMAGING AND VIDEO CONTENT

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I hereby release my image should photos be taken in group activities that may later appear on future media, for websites, social, or any press purposes. I give my permission to use my likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, that I send to Georgina Crickmere of One Yoga Wellness and or to their social media. I agree that anything I send to Georgina Crickmere of One Yoga Wellness have complete ownership of such pictures, etc., including the entire copyright, and may use them for any purpose. These uses include, but are not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including the Internet. I acknowledge that I will not receive any compensation, etc for the use of such pictures, etc. By completing this release, responding to this email, showing up for the session with Georgina Crickmere of One Yoga Wellness and entering any space held by them I agree to these terms.

 

4. INDEMNITY

 

I, the Client agree to irrevocably release and waive any and all claims have I have now or may have hereafter against the facilitators of this session, including Georgina Crickmere of One Yoga Wellness and affiliates, contractors and/or employees/ volunteers. I indemnify and hold harmless Georgina Crickmere of One Yoga Wellness and affiliates, contractors and/or employees/ volunteers for any injuries, illnesses, and the like, experienced as the result of this breathwork session.

 

5. I have fully read, and fully understand and agree to the above terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognise that my signature serves as complete and unconditional release of liability to the greatest extent allowed by law.

 

6. ENTIRE AGREEMENT

 

This document reflects the entire agreement between the Parties and reflects a complete understanding of the Parties with respect to the subject matter. This Contract supersedes all prior written and oral representations. The Contract may not be amended, altered or supplemented except in writing signed by Georgina Crickmere of One Yoga Wellness.

 

7. LEGAL AND BINDING CONTRACT

 

This Contract is legal and binding between the Parties as stated above. This Contract may be entered into and is legal and binding all over the world. The Parties each represent that they have the authority to enter into this Contract.

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8. SEVERABILITY

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If any provision of this Contract shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. If the Court finds that any provision of this Contract is invalid or unenforceable, but that by limiting such provision it would become valid and enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited.

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9. APPLICABLE LAW

 

This Contract shall be governed and construed in accordance with the laws of the state where the event is held, without giving effect to any conflicts of laws provisions.

 

BY SIGNING BELOW & TURNING UP TO THE SESSION, I, THE CLIENT ACKNOWLEDGE HAVING READ AND UNDERSTOOD THIS CONTRACT AND THAT I, THE CLIENT ARE SATISFIED WITH THE TERMS AND CONDITIONS CONTAINED IN THIS CONTRACT. THE CLIENT SHOULD NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME YOU SIGN IT. ACKNOWLEDGMENT I AM IN GOOD PHYSICAL AND MENTAL HEALTH AND DO NOT SUFFER FROM ANY MEDICAL OR PHYSICAL CONDITIONS THAT COULD CONSTITUTE A DANGER TO MYSELF OR OTHERS AS A RESULT OF MY PARTICIPATION IN THE ACTIVITIES, AND I ACCEPT TO PARTICIPATE IN THE ACTIVITIES FREELY.

 

I acknowledge that I have read and completely understand the terms of the release, that I am legally of sound mind, and voluntarily agree to the terms and conditions stated above.

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