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Somatic Wisdom Institute Participation Waiver

For all participants involved in Somatic Wisdom Institute activities including but not limited to Somatic Wisdom Institute Retreats, Somatic WisdomInstitute Ceremonies, Somatic Wisdom Breathwork on the properties of, but not limited to,1324 Lake Drive SE, Suite 4, Grand Rapids, MI, 538 Indian Lakes NE Sparta MI. 49345

Somatic Wisdom Institute Breathwork

  • I understand that Somatic Wisdom Breathwork includes physical movement, breath, meditation, release of emotions, consensual touch, bodywork and sound. I understand that these modalities give an opportunity for release of chronic muscular tension and free flow of energy in the body. 
  • As is the case with any physical activity, the risk of injury, even serious disabling, is always present and cannot be entirely eliminated. If I experience pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from a facilitator. I will continue to breathe smoothly. I assume full responsibility for any and all damages, which may incur through participation. 
  • I understand that the facilitator does not diagnose illness or disease and does not prescribe medical treatment or pharmaceuticals. 
  • I understand that Somatic Wisdom Breathwor is not substitutes for medical care and that it is recommended that I work with my primary caregiver for any condition I may have. 
  • I confirm that I am not pregnant, nor have severe asthma, severe heart disease, a mental illness, epilepsy/history of seizures, acute physical injuries or severe diabetes. 
  • Somatic Wisdom Breathwork is not recommended under certain medical conditions. These are contraindications, to which I have been made aware. I will make the facilitator aware of any medical conditions or physical limitations before the session. 
  • I am not intoxicated by alcohol or drugs. 

Release of Liability + Emergency Contact

I also affirm that I alone am responsible for deciding whether to participate in any Somatic Wisdom Institute related activities and that participation is at my own risk. I acknowledge and affirm that my participation in any on-property activities such as, but not limited to, the use of the sauna, hot tub, and cold tub, is solely voluntary and I accept full responsibility for any associated risks involved and release any liability to Somatic Wisdom Institute/ for personal or physical injuries resulting from my voluntary participation in these activities.

I hereby release and agree to hold Somatic Wisdom Institute and the property owners of 1324 Lake Drive SE, Suite 4, Grand Rapids, MI 49506 and 538 Indian Lakes NE Sparta MI harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the institute, or that may otherwise arise in any way in connection with this training received from Somatic Wisdom Institute. I understand that this release discharges Somatic Wisdom Institute from any liability or claim that I, my heirs, or any personal representatives may have against the institute with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any training received from Somatic Wisdom Institute. This liability waiver and release extends to the institute together with all entities, properties, owners, partners, facilitators and employees associated with Somatic Wisdom Institute.

Today's Date: August 1, 2025



First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
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Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
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Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
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Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
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Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
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Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
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Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
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Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email
Check to join our mailing list and keep up to date with offerings, events, and more.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
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*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
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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