Double-Helix Breathwork Precautions & Liability Forms

Double-Helix Breathwork water precautions (should never be practiced alone in water - risk of passing out and drowning.)*

I will only practice on dry land.

I agree to not consume any recreational substances prior to attendance at the Double-Helix Breathwork event. I will come with an open heart and mind.*

I will arrive sober and free from all recreational substances, with an open heart and mind.

Any advice given by the facilitator(s) is merely informational and educational in nature and are not intended as a diagnosis or prescription for treatment.*

I acknowledge that the facilitator(s) are not acting in the capacity of physicians, physiotherapists, registered dietitian, registered massage therapists, or psychotherapists. He/she will not be held liable for failure to diagnose or treat an illness, nor will he/she be liable for failure to prevent future illness.

Double-Helix Breathwork can bring discomfort to the surface.*

It is my responsibility to notify my facilitator if I am feeling uncomfortable, unsettled or ungrounded during or after a session.

I give my facilitator(s) permission to use light touch, only when necessary to support my journey. (applicable for in person only).*

YES - I grant permission for light touch to support my journey.NO - I prefer no touch.

Smoke Medicine (sage/paulo santo/tobacco) may be used for short periods during the event for the purposes of cleaning and clearing the environment. (applicable for in person only).*

YES - I am okay with smoke medicine.NO - I am not okay with smoke medicine due to sensitivities to smells.

We will be offering Cacao as an option during the ceremony. Cacao is used in ceremonial practices to open the heart. Ingredients are: Organic Guatemalan Cacao, Water, Raw Cinnamon, Ginger, Madagascar Vanilla Bean, Coconut Oil, Organic Maple Syrup. (applicable for in person only).*

YES - I have no allergies to the ingredients and can drink the cacao offering.NO - I am allergic to one or more of the ingredients and cannot drink the cacao offering.

Photography for Promotional Purposes - there will be photography/videography for the purposes of promotional material only. **NO PHOTOGRAPHY / VIDEOGRAPHY WILL OCCUR DURING THE BREATHWORK PORTION OF THE EVENT. (applicable for in person only).*

YES - I give permission for my image to be used in photography / videography for the purposes of promotional material.NO - I prefer not to be included in any photography / videography.

Liability & Claims*

I waive any right to initiate any claims or litigation against the facilitator(s) for his/her advice, medicine recommendations, assessments, and all outcomes of his/her services.

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