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RELEASE, WAIVER OF LIABILITY, AND INDEMNITY AGREEMENT

I, the participant understand that in participating in consultations, coaching sessions, breathwork sessions, breathwork immersions and ice baths, video(s), and audio(s) (collectively referred to as “Activities”) offered by

(Breathwork facilitator) Gianni Neiviller of respirOspace 

I agree to the following:

SERVICES & DISCLOSURE.

I understand that breathwork and Activities offered by Releasees Gianni Neiviler respirOspace are designed to enhance quality of life and support holistic wellbeing, and are not intended to constitute medical advice or any substitution for medical care. I understand that Activities are not intended to be relied upon for diagnosis or treatment in relation to any health problem, and services of the Facilitator do not replace the care of licensed professionals.

MEDICAL DISCLAIMER & CONTRAINDICATIONS.

I understand that Breathwork and Activities may involve strong connected breathing, which can result in dramatic experiences accompanied by strong emotional and physical responses. I understand that I may find the Activities physically, emotionally, or mentally stressful, and that breathwork and Activities may not be safe under certain medical conditions and not advised for persons with a history of cardiovascular disease or prior heart attack, high blood pressure, use of prescription blood thinners, epilepsy or seizures, glaucoma, osteoporosis, severe asthma, bipolar disorder, schizophrenia, dissociative disorders, history of significant trauma, and during pregnancy.

I hereby state that I am not pregnant, and if any of the above conditions apply to me, I will advise the Facilitator prior to participation. I understand that the Facilitator is not qualified to evaluate my fitness for involvement in the Activities, and that I am fully responsible for seeking medical help to treat all symptoms that are present before and after the Activities. I hereby state that I am physically and mentally fit to participate in Activities, and understand that it is solely my responsibility to seek professional support after Activities if I feel unstable mentally or emotionally. I knowingly waive any claim I may have against the Releasees Gianni Neiviler respirOspace for injury or damages that I may sustain as a result of participating in Activities.

RISKS.

I understand and acknowledge that the Activities in which I am participating in bear certain known inherent risks that contribute to the unique character of these Activities, and that Facilitator cannot eliminate, alter, or control these inherent risks. “Risks” include, but are not limited to, known and unknown health conditions, inaccessibility to immediate medical attention, risks inherent in breathwork that include, but are not limited to, over-exertion, psychological distress and disorientation, hyperventilation, respiratory alkalosis, muscle spasms, chest pain, numbness, heart attack, death, and injury or death caused by negligence on the part of Participant or other people around Participant.

I hereby expressly and specifically assume the risk of injury or harm, and agree that my involvement in Activities is purely voluntary, and that I elect to participate in spite of the Risks.

CONFIDENTIALITY.

I understand that unless otherwise explicitly stated, Activities offered will not be recorded or shared, and no photograph(s), video(s), or audio(s) will be taken for marketing purposes or otherwise. I understand that information shared with the Facilitator is privileged communication and strong ethical standards of confidentiality are maintained. I understand that in voluntarily revealing personal information in group Activities, rights of privacy and confidentiality are waived and cannot be guaranteed. I also understand that confidentiality may be waived, without consent, if there is imminent danger to yourself or others, or there is occurrence of child, elder, or dependent adult abuse or neglect. I will refer to the Company’s PRIVACY POLICY for information about how personal data is collected, stored, and used when registering for Activities or Company’s newsletter.

METHODOLOGY, WARRANTIES, & OUTCOMES.

I agree to be open minded to Facilitator’s methods and partake in Activities and services as proposed and instructed. I understand that Facilitator has made no guarantees as to the outcome of Activities, and that information and testimonials presented before, during, or after Activities do not constitute a warranty of specific outcomes.

LIMITATION OF LIABILITY.

By using respirOspace's services and purchasing Activities, I accept any and all risks, foreseeable or non-foreseeable, arising from such a transaction. I agree that Facilitator will not be held liable for any damages of any kind resulting or arising from including but not limited to; direct, indirect, incidental, special, negligent, consequential, or exemplary damages happening from participation in Activities or use of materials provided.

INDEMNIFY & HOLD HARMLESS.

By clicking “Register,” “Purchase,” “Buy Now,” "Click To Sign," or any other phrase on the purchase button, entering my credit card information, or otherwise enrolling, electronically, verbally, or otherwise in Activities, I, in my personal name and on behalf of my relatives, heirs, legal representatives, and assigns, agree at all times to release, indemnify and hold harmless Releasees, as well as their affiliates, employees, students, joint venture partners, successors, assignees, and licenses, as applicable, from and against any and all claims, causes of action, damages, liabilities, costs, and expenses, including legal fees and expenses, arising out of or related to Activities. I knowingly and freely assume all risks, both known and unknown, even if arising from the negligence of the Releasees or others, and assume full responsibility for my participation in Activities.

Today's Date: November 30, 2022 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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