• Beyond Breath Lab Waiver and Medical Questionnaire

  • I hereby ackgnowledge that I am aware of my right to access my personal information.*

     

    I hereby ackgnowledge that I am aware of my right to withdraw my consent at any time.*

     

    I understand that Beyond Breath Lab must comply with relevant privacy laws and I will contact Beyond Breath Lab immediatelly if I feel that these laws have been breached. (daniela@beyondbreathlab.com). *

  • Beyond Breath Lab Waiver and Medical Questionnaire

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  • Welcome to Beyond Breath Lab!

     

    We are excited about embarking on this journey with you. At Beyond Breath Lab, your wellbeing and safety is our paramount concern. As such, we need to ensure that you're taking the right precautions prior to embarking on any journey with us. 

    Please read this release and waiver of liability form carefully before signing. This document is legally binding agreement between you (the Participant) and Beyond Breath Lab, the company organising health and wellbeing workshops, retreats, cold temperature exposure experiences and breathwork. By signing this form, you acknowledge that you have read, understood, and agreed to the terms and conditions outlined below.

    Assumptions of Risk

    I understand participating in breathwork and cold exposure involves inherent risk, both known and unknown. These risks may include, but are not limited to:

    Health risks associated with breathwork and cold exposure, including hyperventilation, breathholding, changes in blood pressure, drowning, implications from extreme cold exposure and potential adverse reactions.

    I acknowledge that I am voluntarily participating in these activities with knowledge of the potential risks involved, and I assume full responsibility for my own safety and well-being. I further acknowledge that any experience I am guided through with instructors should not be attempted unsupervised on my own accord or without vigorous training and extensive experience, and in all circumstances, not near or in a body of water, in proximity to other hazards, or without access to suitably qualified healthcare professional. 

    Medical Disclosure and Assessment

    I certify that I am in good physical and mental health, and I will disclose all relevant medical information to Beyond Breath Lab in the Medical Questionnaire. I understand that it is my responsibility to undergo appropriate medical checks, assessments, and consultations with a qualified healthcare professional prior to participating in any event, activity organised by Beyond Breath Lab.

    I further acknowledge that when I answer "YES" to any question in the Medical Questionnaire, I must provide Beyond Breath Lab with evidence of medical fitness relevant to the positive medical disclosure from a qualified healthcare professional in the preceding six (6) months to your participation in any Beyond Breath Lab event, activity or course.

    This may include any of the below:

    • Full medical examination and assessment of general health and fitness level.
    • Cardiovascular assessment, including but not limited to blood pressure, heart rate and electrocardiogram (ECG).
    • Pulmonary function test (spirometry) and assessment of respiratory health.
    • Ear, nose, and throat examination to evaluate equalisation capabilities and potential risks associated with pressure changes.
    • A list of any medications or treatments you may require and any impact on participation.


    Any other medical assessments deemed necessary by a suitably qualified healthcare professional based on the nature of the workshops, activities and courses.I understand that if I fail to provide the required evidence or if any medical condition or risk factor is identified during the assessments that may compromise my safety or the safety of others, Beyond Breath Lab reserves the right to deny my participation in any activity, workshop or course notwithstanding the provision of any evidence of medical fitness provided by a healthcare professional at its full and sole discretion. You acknowledge this is for your own wellbeing and safety.

    Requirement of Insurance

    I acknowledge that participating in Beyond Breath Lab health and wellbeing workshops, retreats, cold exposure experiences and breathwork includes certain risks and hazards. While Beyond Breath Lab itself maintains insurance coverage for the activities it engages in, I understand and agree that it is my responsibility to obtain and maintain my own personal insurance coverage that provides adequate protection against any personal injury, property damage, or other losses that may occur during my participation in the occasion that Beyond Breath Lab insurers do not accept any claim I may make.

    I confirm that I have obtained my own insurance coverage and will maintain it for the duration of my participation. I understand that Beyond Breath Lab will not be responsible for any costs or expenses arising from personal injury, property damage, or other losses that may occur during the event or activity you may embark on with Beyond Breath Lab.

    Release of Liability

    In consideration for being permitted to participate in Beyond Breath Lab health and wellbeing workshops, retreats, cold temperature exposure experiences and breathwork, I hereby waive, release, and discharge Beyond Breath Lab, its directors, employees, instructors, agents, and contractors from any and all claims, demands, actions, causes of action, liabilities, costs, and expenses, including attorney’s fees, arising out of or related to any loss, damage, injury or death that may occur during or as a result of my participation. To the fullest extent permissible at law, I hereby so waive and release on behalf of any agents, assigns, executor, trustee, beneficiary, heir or other party and discharge Beyond Breath Lab in the manner so described above.

    I agree to indemnify and hold harmless Beyond Breath Lab against and all claims or liabilities arising out of my actions or conduct while participating in the activities organised by Beyond Breath Lab.

    Consent for Sharing of Health Information

    I understand that ensuring the health and safety of participants is of utmost importance to Beyond Breath Lab. In order to implement appropriate health and safety measures, I hereby consent to the sharing of my health information disclosed in the Medical Questionnaire with Breathless instructors and authorised personnel. This sharing of information will be done in accordance with the Australian Privacy Principles and Privacy Act 1998, which govern the collection, use, and disclosure of personal and sensitive information.

    I acknowledge that the sharing of my health information is necessary to assess my suitability for participation in health and wellbeing workshops, retreats, cold temperature exposure experiences and breathwork organised by Beyond Breath Lab. I understand that this information will be treated with the utmost confidentiality and will only be used for the purpose of ensuring my health and safety during the activities.

    I further acknowledge that Beyond Breath Lab will take reasonable measures to protect the privacy and security of my personal health information in accordance with applicable privacy laws and regulations.

    Photographic and Video Release

    I grant Beyond Breath Lab the right to use, reproduce, and publish any photographs, videos, or other media taken during the expeditions or activities for promotional, marketing, or educational purposes without compensation or further consent. I understand that I am consenting to the use of photographs and video of my likeness to be used as Beyond Breath Lab deems fit.

    Severability and Governing Law

    If any provision of this waiver of liability form is found to be unenforceable or invalid, the remaining provisions shall continue in full force and effect. This agreement shall be governed by and constructed in accordance with the laws of Victoria without regard to its conflict of laws principles.

    I understand and agree that I am not only giving my up right to sue Beyond Breath Lab or any of its instructors and authorised personnel but also any rights my heirs, assigns, or beneficiaries may have to sue resulting in the unlikely occasion of my death.

    I have read this waiver of liability form, fully understand its terms and conditions, and voluntarily agree to be bound by them. I understand that by signing below, I am releasing certain legal rights and that my signature serves as a complete and unconditional release of liability.

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  • Medical Questionnaire

  • If you have answered "YES" to any of the questions above, you will be required to provide evidence of medical fitness to Beyond Breath Lab relevant to the positive medical disclosure from a qualified healthcare professional. 

    Failure to address answering "YES" to any of the above conditions prior to engaging in breathing, breath holding or cold-water immersion (also referred to as "ice baths") activities, may endanger your health as well as the safety of other participants.

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