I/we prioritize the safety and well-being of all our participants, and as part of
our commitment to ensuring a secure environment, we require the completion
of this Liability Waiver Form.
A breathing session may not be suitable for you if you have the following
conditions:
Cardiovascular problems, abnormally high blood pressure, aneurysms,
epilepsy and seizures in the past, anyone taking heavy medication, severe
psychiatric symptoms especially psychosis or paranoia, bipolar, osteoporosis,
recent surgery, glaucoma or is currently pregnant.
People with asthma should bring their own inhaler and consult with their
physician and breathing session instructor before participating.
Anyone experiencing an emotional or spiritual crisis or any person with a
mental illness who is not in treatment or lacks adequate support.
Please note, this list is not exhaustive and we generally advise that if you
have a question about a condition you may have that is not listed here, you
consult a physician before participating in these breathing sessions.
I warrant and represent that I am in good health physically, mentally,
psychologically and emotionally, and I understand and warrant that if I am not
in good health I will not be allowed to perform the activities and sessions.
Accordingly, the declaration and certification that I am in good health in all the
above-mentioned respects constitutes a material agreement to allow me to
participate in the breathing sessions.
I know and acknowledge that the person facilitating is not a doctor or
psychiatrist, or a specialist in health care, and that the activities offered are
not intended to treat and diagnose specific medical conditions, whether
physical, psychological or emotional.
I voluntarily participate in these activities knowing the risks and
consequences and agree to assume all consequences, known or not.
I release trainer Moana Hancock from all responsibilities, costs and
damages that may arise from participating in the above-mentioned activity.
I agree to accept financial responsibility for costs related to treatment.
By adding my name below, I acknowledge that I have read the above warning
and agree to proceed with full responsibility, and understand that I have
waived certain rights by signing and signing this release of liability freely and
voluntarily without any external influence.