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

Name of Practitioner: Participant
Name of organization, company, or legal entity: Power to Heal Breathwork
The heirs, assigns, successors, employees, volunteers, and/or associates of (Name of practitioner) and/or (name of company, organization, or legal entity).

I, the participant (“the Releasor/attendee”), understand and acknowledge that the discussions, consultations, breathwork session(s), teaching(s), and video(s) I have with the Releasees:

• 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 being limited to: schizophrenia, bipolar disorder, 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 I have consulted 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 if I have or suspect I may 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. Power to Heal Breathwork facilitators make 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 do they make any representation that I will experience any particular outcome on an issue. In the instance of a group process, I may voluntarily reveal personal information, and in doing so, I understand and hereby waive my rights to privacy and confidentiality.

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 Power to Heal Breathwork facilitators.

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) are experiential and the extent of their risks and benefits are not fully known, I agree to assume and accept full and 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.

I agree and understand any and all session(s) may be filmed, photographed, and/or recorded and that the Power to Heal Breathwork facilitators shall have all rights in and to such film, photographs, and/or recordings, including the copyright therein. The copyright shall include, but not be limited to, the right to use, re-use, publish, re-publish, and otherwise reproduce, modify, and display any such film, photograph, and/or recording for educational and promotional purposes, including without limitation audiotapes, audio CDs, DVDs, websites, video, or film, or any other form of recorded images. I grant Power to Heal Breathwork facilitators the right, without compensation to myself, to film, photograph, and/or record me while participating in any and all session(s), and I waive any right which I now have or may have hereafter in any such film, photograph, and/or recording. I agree not to record, by audio, video, photographic, or any other means, any portion of any and all session(s).

In my personal name and that of my heirs and assignees, I exonerate and totally and indefinitely release the Releasees from any suit, complaint, declaration, damage, cost, and/or expense of any kind (whether caused by the passive or active negligence of the Releasees or otherwise) in connection with or resulting from any discussion, consultation, or session(s) I participate in.