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SoulBreath Waiver

DISCLAIMER 

Breathwork & Cold Immersion may not be for you if you have the following conditions:

Pregnancy

Detached Retina

Glaucoma

High Blood Pressure (not controlled with medication)

Cardiovascular disease including angina, previous heart attack or stroke.

Diagnosis of aneurysm in the brain or abdomen

Uncontrolled thyroid conditions and diabetes

Asthma – if you are asthmatic, please bring your inhaler to the session.

Epilepsy

Prior diagnosis of bipolar disorder, schizophrenia or previous psychiatric condition.

Hospitalisation for any psychiatric condition or emotional crisis within the last 10 years.

Any other medical, psychiatric or physical conditions which would impair or affect ability to engage in any activities that involve intense physical and/or emotional release.

This list is not all inclusive and we generally recommend if you have a question about a condition you may have that is not listed, that you consult a physician before beginning breathwork. 

If you have or have had any of the listed conditions, we strongly recommend you consult a physician before beginning breathwork or cold immersion.

WAIVER

This is a dynamic practice and as such, in reading this waiver you agree to take personal responsibility for your process. Please note that this practice is not a substitute for medical advice. The facilitators cannot be held responsible for any mental, physical or emotional challenges which may arise from this work. Elise Griffin takes no responsibility for injury you may sustain as a result of participating in this session. Thank you for taking care of your wellbeing by listening to your body and respecting these guidelines.

For the purposes of this Release and Waiver, the term “Releasees” shall refer to any or all of:


Name of Practitioner: Elise Griffin

Name of organization, company, or legal entity: SoulBreath

The heirs, assigns, successors, facilitators, volunteers, and/or associates of SoulBreath.


I, the participant, (“the Releasor/attendee”), understand and acknowledge that SoulBreath workshops, discussions, consultations, breathwork session(s), cold immersion session(s), teaching(s), videos(s), and audio(s) are not intended to replace any relationship I have with my medical doctor and/or primary health care provider(s);

Are not intended to constitute medical advice or any substitution for medical care;

Are not intended to be relied on for prescriptions, recommendations, diagnosis, or treatment in relation to any health problem or disease;

I understand that if I am taking any medications or have any medical conditions such as, but not limited to: schizophrenia, bipolar, epilepsy, heart conditions, or pregnancy, that I must advise the facilitator/s.

I also understand that even though I have been accepted as a participant, I am responsible for any consequence resulting from any and all session(s).

I certify that it is my responsibility to consult a health professional regarding any condition physical, mental, or emotional that could interfere with my judgment, or affect my health in any way during or after any and all session(s).

I understand and acknowledge that I am responsible for consulting my health care provider or doctor in case I have or suspect to be suffering from a health problem.

I understand the stories or testimonials presented before or during the session do not constitute a warranty, guarantee, or prediction regarding my experience during or after the session. SoulBreath makes no warranty, guarantee, or prediction that I will experience any particular state of awareness or consciousness during or after any and all session(s), nor does it make any representation that I will experience any particular outcome on an issue.

I further understand that my participation in any and all session(s) is not intended to create nor does it establish a client-practitioner relationship or any other type of therapeutic or professional relationship between me and facilitator.

I understand and acknowledge that by participating in any and all session(s), I do so at my own risk. It is with this understanding that I voluntarily sign this waiver. Since any and all session(s) is experiential and the extent of any and all session(s) risks and benefits are not fully known, I agree to assume and accept full complete responsibility for any known and unknown risks associated with my participation in any and all session(s), including any physical injury, psychological or emotional effects, death, loss, or property damage.

In my personal name, that of my heirs and assignees, I exonerate and totally and indefinitely release the relinquishers of any suit, complaint, declaration, damage, cost and/or expense of any kind (that any such prosecution, complaint, declaration, damage, cost and/or expense is caused by the passive or active negligence of the Releasees or otherwise) in connection resulting from any workshops, discussions, consultations, breathwork session(s), cold immersion session(s), teaching(s), videos(s), and audio(s) I experienced.

Payment Policy

Payments are accepted via stripe or bank transfer or cash. Any additional service charges or fees for using third-party payment methods shall be the sole responsibility of the customer. 

Have you read and understood the above?


First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
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*
Check to receive information, news, and discounts by e-mail.
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*

Relationship*

Phone*
Parent or Guardian's 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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