Transformational Breathwork Registration & Waiver Form

Breathwork can bring about intense physical sensations, emotional releases, and profound shifts, with the potential to deeply transform your health, well-being, and state of consciousness.

I am committed to providing a safe and supportive environment for you, so please take a few minutes to review the waiver and fill this form completely before our session. 

If you have any questions, please feel free to reach out to me at kyates8@gmail.com

It is truly an honor to support you through this journey. I am looking forward to breathe with you! 

🪶 Full workshop including preparation, breathwork, and integration
 🌬️Transformational breathwork journey using a connected breathing technique
❣️ A space to share and connect with other breathers in a meaningful way

Practicalities:
- Please wear loose and comfortable clothing
- Please bring a yoga mat or something to lie on (for virtual sessions, please prepare your space comfortably in a way that you can recline completely onto the floor, a bed, mat, or blanket.) 
- You may also wish to bring a blanket, a water bottle and a notebook and pen.

Please do not eat directly before the breathwork journey; I recommend your last meal to be at least 2 hours prior to the session. 

The conscious connected breathwork portion of our session will last about 45-60 min. Working with your breath, accompanied by my guidance and our music, will help you to reach deeper levels of consciousness and healing states in your body. It is very normal to experience emotional catharsis during a session, but it does not always happen. You are likely to leave your session feeling lighter, cleansed, and refreshed in energy. We will have space to share our intentions in the group, but I encourage you to then "let go" and allow whatever needs to arise for you in the session to emerge. 

For online sessions: within 24 hours of completing this form, you will receive a Zoom link to access the session.

After the Event:
A Breathwork Journey can be a very profound and powerful experience. It can take a while to integrate, so after the event I recommend:

- Plan for some space and time afterwards to process the experience. 
- Eat nourishing food and drink plenty of water.
- Give yourself plenty of self-care; spending time in nature, journaling, moving, and avoiding screen time area all wonderful integration practices! 

• I understand that even though I have been accepted as a participant, I am responsible for any consequences resulting from any breathwork practice.

• I certify that I have taken medical advice relating to any physical, mental or emotional condition that may impair my judgment, or have any affect on my physical health, and am able to undertake breathwork.

Breathwork Contraindications (please read thoroughly): 

I understand that if I am taking any medications or have any medical conditions I must advise the facilitator/s and consult with a medical doctor prior to breathing. I understand that this breath style is contraindicated for conditions such as, but not limited to:

1. Epilepsy or history of seizures
2. Schizophrenia, bipolar disorder, psychosis
3. Cardiovascular disease, heart conditions, diagnosed brain or abdominal aneurysm, stroke, or heart attack
4. Recent surgery or unhealed major physical injury
5. Glaucoma, detached retina
6. Asthma (unless you have your inhaler with you)
7. Early stage or complicated pregnancy
8. Uncontrolled diabetes, thyroid conditions, or high blood pressure
9. Panic attacks

While Breathwork may be feasible with certain outlined above conditions, obtaining approval from both your medical provider and Breathwork Facilitator is essential before participation.

• I understand and acknowledge that a Breathwork Session:
  a) are not intended to replace any relationship I have with my medical doctor and/or primary health care provider(s);
  b) are not intended to constitute medical advice or any substitution for medical care;
  c) are not intended to be relied on for prescriptions, recommendations, diagnosis or treatment in relation to any health problem or disease;

• I understand that whilst every care is taken, the facilitator will not be liable for any damage or injury resulting from my practice.

• I understand that loud music is used to support altered states in these sessions. If I have a sensitivity to noise, it is my responsibility to bring earplugs to any group sessions and to let the facilitator know in advance.

• I understand my experiences and actions in the breathwork are fully in my control and if things become too overwhelming, I take responsibility to come back to a normal breath to calm down my system.

• I understand that everything that happens and anything that is said before, during and after a breath session will remain completely confidential, so long as no harm is inflicted on the facilitator. I understand that a breathwork session may include physical touch designed to support me in my journey and that I have the right to refuse touch by using the word ‘stop’ at any time.
   

• I understand and acknowledge that, in undertaking breathwork practices I am doing so at my own risk. It is with that understanding that I voluntarily execute this release and waiver.

 

By filling out and submitting the form, you acknowledge and agree that your electronic checkbox mark constitutes a legally binding agreement, equivalent to your handwritten signature, and that you are voluntarily entering into this waiver and release agreement ("Agreement").