SACRED BREATHWORK EVENT WAVIER

::: IMPORTANT CONSIDERATIONS :::

Below are a list of contraindications for Conscious, Connected Breathing, a breathing technique which changes blood oxygen levels in the body and also allows us to access the subconscious and emotional body. If you are on the contraindication list, you are not a candidate for full breathwork at this time, but we are happy to discuss modified, gentle breathwork with you as an alternative.

Note: Breathwork results in certain specific physiological changes in the body and also can result in intense physical and emotional release. As a precaution, the following conditions are contrandicated in certain breathwork practices. It is crucial that you inform your breathwork practitioner if any of the following conditions are relevant to you:

IMPORTANT: You will not be able to experience the full breathwork today if you have any contraindications listed below.

***

::: CONTRAINDICATIONS FOR BREATHWORK :::

- Pregnancy (at any stage)

- Severe PTSD or Trauma

- Actively using recreational drugs

- Taking any medication that alters brain chemistry (like anti-anxiety, anti-depressant, ADD, OCD medications, etc.)

- Prescription Blood Thinners or Anti-Clotting Medications

- Osteoporosis

- Detached Retina

- Glaucoma

- Kidney Disease

- High Blood Pressure

- Cardiovascular Disease, including Angina, previous Heart Attack, or any other Cardiovascular issues

- Heart Conditions, including Myocarditis and Pericarditis

- Strokes or TIAs

- Seizures, history of seizures or other brain/neurological condition or disease

- Diagnosis of Aneurysm (of any kind)

- Uncontrolled Thyroid Conditions

- Diabetes (any type)

- Infectious or Contagious Disease

- Severe Asthma— for mild to moderate asthma, you can experience breathwork but must bring your inhaler to the session

- Epilepsy

- Prior diagnosis of Bipolar Disorder, Schizophrenia or previous Psychiatric Condition

- Severe Psychosomatic Disorders

- Recent Surgery, Stitches or Major Injury

- Hospitalization for any Psychiatric Condition or Emotional Crisis within the last decade

- Any other Medical, Psychiatric or Physical Conditions which would impair or affect ability to engage in any activities that involve deep physical and/or emotional release

***

IMPORTANT: If you are on the contraindication list, you are not a candidate for the full breathwork technique, but we are happy to discuss modified, gentle breathwork, so as long as changing oxygen levels in the body does not interfere with your condition. Exceptions would include diabetes, kidney conditions and thyroid conditions. For these specific conditions, changing blood oxygen levels could be life-threatening and unfortunately we cannot ethically offer you breathwork.

***

Conscious, Connected Breathwork results in certain specific physiological changes in the body and also can result in intense physical and emotional release. Please be aware that these sessions are safe, illuminating, transformative and deeply healing, and can sometimes cause the following:

* Tingling

* Buzzing

* Vibrating

* Shaking or other physical sensations, including spontaneous physical movement

* Tetany (tightness in the hands or sometimes the jaw- we will guide you on how to work with it and manually release it if required)

* Somatic (body) unwinding

* Deep emotional experiencing, release and catharsis

* Trauma release

* Experiencing life force energy (prana) moving through your body

* Unlocking repressed energies to heal and clear them

____________________________________________________________________________________

DISCLAIMER OF LIABILITY
Spiritual and emotional work, breathwork, yoga, meditation and any other form of alternative healing should not be construed as a substitute for direct medical advice from your doctor or other qualified clinician, medical or psychiatric examination, diagnosis or treatment. Anyone interested in breathwork is also responsible for seeking the specific medical or psychiatric attention they need, should they need it.

The information and content available is intended for informational purposes only. It is not intended to diagnose, mitigate, treat or cure any disease or condition. Individuals should consult a qualified health care provider for medical or psychological advice.

::: WAIVER AGREEMENTS :::

Commitment to Deep Work:
I acknowledge that this practice involves intense self-exploration, and I am prepared to meet any emotional, physical, or mental experiences that may arise. I am in a grounded and emotionally stable place, ready to meet any latent trauma or emotional experiences healing and integration. I willingly engage in this process.

***

Guidelines and Contraindications:
I confirm that I have read and understood the SBA guidelines, disclaimers, and contraindications list. I agree to abide by all considerations provided for safe participation.

***

Disclosure of Medical Conditions:
I confirm that I do not have any of the listed contraindications or have disclosed any relevant conditions prior to this session.

***

Understanding of Breathwork Risks:
I understand that CCB involves specific physiological and emotional responses and may not be suitable for everyone. The SBA emphasizes non-aggressive, parasympathetic-driven practices. I acknowledge my responsibility to listen to my body and communicate any discomfort or distress to the facilitator.

***

Assumption of Responsibility:
I, the participant, voluntarily join this Breathwork Intensive, assuming full responsibility for my physical, mental, emotional, and spiritual wellbeing. I release and hold harmless Sacred Breath Academy, its facilitators, and all affiliates. I am ready for the journey and acknowledge the above terms.

***

Confidentiality Agreement:
I understand that all discussions, emotional releases, and personal experiences shared during the session are confidential and will not be disclosed by the facilitators without my express written consent, except in cases where safety or legal obligations arise.

***

Media Release:
I consent to Sacred Breath Academy (occasionally) capturing photos and/or video recordings during sessions and graduation. I understand that these may be used for educational or promotional purposes, and I grant SBA permission to do so. (Optional: Participants can opt out of this clause by notifying the facilitator in advance.)

***

Informed Consent:
I confirm that I have read and understood the waiver and all relevant details of this practice. I have been given the opportunity to ask questions, which were answered to my satisfaction, and I consent to participate willingly.

***

Right to Withdraw:
I understand that my participation in this breathwork session is voluntary and that I may choose to stop participating at any point without explanation. My decision to withdraw will not be held against me.

***

Indemnification:
I agree to indemnify and hold harmless Sacred Breath Academy, its affiliates, and its facilitators from any claims, liabilities, or expenses arising out of my participation in this breathwork session.

THE FOLLOWING IS A LEGALLY BINDING DOCUMENT. WE TRUST THAT ALL PERSONS WILL ANSWER IN HONESTY AND GOOD FAITH.This document underscores the importance of personal responsibility, facilitator support, and ethical practice in breathwork.

CONSENT FORM & RELEASE OF LIABILITY

Name

First Name

Last Name

Date of Birth

YYYY

Emergency Contact: Name + Phone Number

Do you have any contraindications to breathwork?

If so, please list below.

Do you have any other medical or psychological conditions that we should be aware of? If so, please list below. *

SELF-CONTRACT: 1 - I am ready for this DEEP WORK and to meet myself in all parts of my experience (even in a growth edge) for my greater healing and transformation. I am in a grounded and emotionally resourced place in my life to journey into my subconscious body, including meeting any latent trauma that may potentially arise through breathwork. I am able and willing to go into all layers of my being. INITIAL IF YOU AGREE

2 - Confirm that you have read and agree to the SBA guidelines, disclaimer and contraindications list. *INITIAL IF YOU AGREE

3 - Confirm that you have NO contraindications listed to experience the full breathwork and have disclosed any existing medical conditions before the session. *INITIAL (unless previously stated otherwise)

4- I, the Participant, understand that Breathwork is a powerful experiential tool for accessing my own inner healer and can greatly intensify my self-transformation. Through the art of deep diaphragmatic breathing along with the guidance of a skilled practitioner and intentional music, I will embark on a deep journey within. Because this process can potentially bring up intense emotions and strong physical experiences or sensations, I have been advised that it is not recommended for those with certain types of cardiovascular ailments or history of heart attack, epilepsy, recent surgery, pregnancy (at any stage), mental health imbalances, psychosomatic ailments, severe asthma, chronic disease, infectious disease, other physical limitations or unprocessed trauma. *INITIAL IF YOU AGREE

5 - I hereby acknowledge that I have no such problems or conditions as listed above, or any other physical, mental or emotional conditions that would prevent me from participating in a Breathwork immersion. I have fully disclosed my physical, mental and emotional background to the facilitators involved prior to my participation. I realize that all staff, assistants, volunteers and/or agents are here only as a guide to my process and that none of the staff, assistants, volunteers and/or agents are here to replace any form of traditional mental or health treatment. I have spoken with any and all mental and physical health care professionals that I believe would be necessary to ask whether I would be an appropriate candidate to participate in the Breathwork process, based on my physical, emotional and mental health history and current condition(s). I hereby attest that there is no reason why I should not be able to participate. * INITIAL IF YOU AGREE

6 - To this purpose, I, the Participant, voluntarily participate in the Breathwork Intensive with Sacred Breath Academy, and accept full responsibly for my own physical, mental, emotional and spiritual wellbeing, releasing and holding harmless Sacred Breath Academy and all affiliates. I am ready for the journey with a full-bodied YES! *INITIAL IF YOU AGREE

7- I hereby agree that by signing this document, I consent to waive the right to sue the Organizer (Sacred Breath Academy) or Retreat Location (Facility Rental), and if applicable any agents, directors, representatives, officers, facilitators and organizers, for any physical, material, tangible or intangible, loss or damages that may happen to me during my participation in the Retreat and Intensive. I will be voluntarily participating in the Retreat and Intensive. * INITIAL IF YOU AGREE *

8- I understand and am aware that my participation in the Retreat and Intensive and any excursions I choose to participation involves risk and I assume them at my own liability. I hereby acknowledge that I am voluntarily participating in the Sacred Breath Retreat and Training and I am participating in all activities entirely at my own risk. I am aware of the risks associated with traveling to and from as well as in participating in all activities. Nonetheless, I assume all related risks, both known and unknown to me, for the duration of the Retreat, including travel to and from. I also acknowledge that the Sacred Breath Intensive and Retreat may include spiritual reflection, breathwork, and emotional instruction as a part of an alternative holistic health program and understand that I accept full responsibility for my healing process and participation in this Training. I further understand that spiritual counseling, breathwork, yoga, meditation instruction and any other form of alternative healing should not be construed as a substitute for medical/psychiatric examination, diagnosis or treatment and that I am responsible for seeking out the specific attention I need, should I need it. I freely enter into the Sacred Breath Retreat and Training and all activities at my own risk and with full responsibility. I expressly and voluntarily waive and release the facilitators of the Retreat and Training from any and all liability for any claims, demands, and/or actions of any kind, including but not limited to, personal injury and/or property damage that may occur as a result of or in the course of my retreat and/or arising out of the use of the lodging premises. In the event that any damage to equipment or facilities occurs as a result of my actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness. I further agree to defend, indemnify and hold harmless the Retreat facilitators from any and all claims, actions or demands by any other party or individual which may arise out of or result from my participation in any Sacred Breath Retreat and Training activities. I hereby warrant and represent that I am in good health and have no physical condition or disability which would be aggravated by or give rise to risk of harm to me by my participation in any Sacred Breath activities. I acknowledge that I have read and understand the contents of this waiver and agree to the above terms and agreements. *INITIAL IF YOU AGREE

SACRED BREATHWORK EVENT WAVIER

::: IMPORTANT CONSIDERATIONS :::

::: CONTRAINDICATIONS FOR BREATHWORK :::

THE FOLLOWING IS A LEGALLY BINDING DOCUMENT. WE TRUST THAT ALL PERSONS WILL ANSWER IN HONESTY AND GOOD FAITH.This document underscores the importance of personal responsibility, facilitator support, and ethical practice in breathwork.

WELCOME TO THE SACRED BREATH EXPERIENCE… SEE YOU VERY SOON!

in joyous reverence of breath

© 2023 by SACRED BREATH academy. All Rights Reserved.