Breathwork Liability Waiver and Release Form

Health Conditions and Consultation:

Participation in a breathwork session may not be suitable for individuals with certain health conditions. The following is a non-exhaustive list of conditions that may affect your ability to safely participate:

• Cardiovascular problems

• Abnormally high blood pressure

• Aneurysms

• Epilepsy or history of seizures

• Heavy medication use

• Severe psychiatric symptoms, particularly psychosis, paranoia, or bipolar disorder

• Osteoporosis

• Recent surgery

• Glaucoma

• Pregnancy

• Unmanaged mental illness or lack of adequate support during an acute emotional or spiritual crisis

If you have asthma, please bring your inhaler and consult with your physician and the breathwork session instructor before participating. This list is not exhaustive. If you have any medical or psychological conditions not listed, or if you are uncertain about your health status, consult a physician before participating.

Participant Acknowledgment of Health Status:

I affirm that I am in good physical, mental, psychological, and emotional health to participate in breathwork sessions. I understand that declaring false health information can result in immediate removal from the session and future sessions. My signature confirms my understanding that I must be in good health to participate and that I am responsible for assessing my readiness for the activity.

Role of the Facilitator:

I acknowledge that the breathwork session facilitator is not a licensed healthcare provider and that the session is not intended to diagnose, treat, or manage any medical or psychological condition. The guidance provided is for informational purposes only.

Risk Acknowledgment and Liability:

I am aware of the inherent risks associated with breathwork sessions and voluntarily agree to assume those risks. I acknowledge that it is my responsibility to inform the instructor of any limitations or medical conditions that may affect my participation and to cease participation if I experience discomfort or adverse effects.

Emergency Procedures:

In the event of an emergency, I understand that the facilitator will follow established procedures to provide immediate response and facilitate access to medical care if needed. However, I agree that the facilitator is not responsible for the outcomes of such emergencies.

Mental Health:

If I experience unexpected psychological distress as a result of the session, I will inform the facilitator immediately and seek professional help if necessary. I acknowledge the importance of mental health support and agree to take personal responsibility for my psychological well-being.

Data Protection:

I understand that any personal information provided will be used solely to facilitate my safe participation in the breathwork sessions and will be protected and stored securely in compliance with applicable data protection laws.

Waiver of Liability and Hold Harmless Agreement:

Waiver of Liability:

I hereby release, waive, discharge, and covenant not to sue Randy Gates, Breath of Fire, its facilitators, employees, volunteers, agents, the owners/lessors of the premises where the breathwork sessions are conducted, and any partners or affiliated entities from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, injury (including death), or expense that I may suffer, or that my next of kin may suffer, as a result of my participation in breathwork sessions, whether caused by the negligence of the Releasees or otherwise, to the fullest extent permitted by law.

Hold Harmless:

I agree to hold harmless the Releasees from any and all claims, actions, suits, procedures, costs, expenses, damages, and liabilities, including attorney's fees, brought as a result of my involvement in the breathwork sessions and to reimburse them for any such expenses incurred.

Acknowledgment of Understanding:

 I acknowledge that this waiver of liability and hold harmless agreement is a legal document and that it is intended to be as broad and inclusive as permitted by the law. I have read this document thoroughly and understand its contents. I am aware this is a release of liability and a contract between myself and Randy Gates, Breath of Fire and its affiliates and sign it of my own free will.

Electronic Signature and Acceptance Agreement:

By selecting the "I Agree" button below, I am signing this Agreement electronically. I agree that my electronic signature is the legal equivalent of my manual signature on this Agreement. By selecting "I Agree," I consent to be legally bound by this Agreement's terms and conditions.

Affirmation of Electronic Submission:

I understand that by agreeing electronically, I am confirming that I have read and understood the terms and conditions of this Breathwork Liability Waiver and Release Form and that I am voluntarily agreeing to all the stipulations contained within it. I acknowledge that my electronic submission constitutes my agreement and intent to be bound by the terms of this waiver.

Enforceability and Recognition of Electronic Signature:

I understand and agree that the law recognizes electronic signatures and records as valid and enforceable contracts, legal and binding in the same manner as traditional paper-based documents signed in ink. The use of an electronic version of this document fully satisfies any requirement that the document be provided to me in writing. I am fully aware that my agreement to the use of electronic documents and signatures carries the same weight and legal effect as if I had executed this document in paper form with a pen-and-ink signature.