BREATHWORK LIABILITY WAIVER & RELEASE FORM
TERMS AND CONDITIONS
The parties agree to the following terms and conditions:
a. Client is engaging in breathwork and Spinal Energetics services to be provided by Usamah Aissou and Spirasana and affiliates, contractors and/or employees/volunteers. This includes any services provided during retreats organized by Spirasana.
b. Client agrees to sign this Informed Consent and Assumption of Risk and Release of Liability.
c. This session is not recommended and is not safe under certain medical conditions. I, the client, agree to inform all staff, including Usamah Aissou and Spirasana and affiliates, contractors and/or employees/volunteers, of any medications I am currently taking, and medical conditions or physical limitations I have prior to the event. This disclosure requirement extends to participation in any retreat activities. I will disclose any and all conditions, medical or otherwise, that may affect my ability to participate in this breathwork and Spinal Energetics session and retreat activities. This includes present or near past experiences of experiencing severe mental illness, neurological conditions, heart conditions, history of blood clots, currently experiencing spiritual emergence/crisis, epilepsy and seizures, detached retina and other ocular issues, heart conditions/attacks, high blood pressure, pregnancy, recent physical injuries, fractures and surgeries. For retreat attendees, additional considerations include readiness for intensive group activities and communal living environments associated with retreat settings. I confirm that I am not pregnant, nor do I have severe asthma, heart disease, diabetes, a mental illness, epilepsy/history of seizures and/or acute physical injuries or any other contraindications of breathwork. In case of retreat participation, I also affirm my readiness to engage in group activities and respect the communal living agreements. In the case of any of these conditions I understand participation will be revoked and I will not be allowed to participate in the session or retreat as a precaution to my health and wellbeing.
d. I understand that the facilitator of this session, including their affiliates, contractors, and/or employees/volunteers, do not diagnose illness or disease and this session does not prescribe or replace medical treatment or pharmaceuticals.
e. As is the case with any physical activity, the risk of injury, is always present and cannot be entirely eliminated. If I experience any unusual pain or discomfort, I will listen to my body, discontinue the activity, and clearly communicate this to the facilitator and ask for support. I assume full responsibility for any and all damages, which may incur through participation in this session or any retreat activities.
f. I understand that this breathwork and Spinal Energetics session, as well as any activities undertaken during a retreat, is not a substitute for medical care and it is recommended that I continue to work with my primary health care provider for any condition that I may have.
g. I understand taking alcohol or drugs prior to, or during this session or during any part of the retreat, will result in me not being able to participate in the session. I agree that I will not be under the influence of drugs or alcohol whilst attending this session or the retreat.
h. I confirm that I, alone, am responsible for deciding whether to participate in the breathwork session or any retreat activities and that I participate fully at my own risk.
i. I understand that this session and the retreat includes breathwork, Spinal Energetics, and trauma release, which is made up of physical movement, breathing, meditation, release of emotions, touch, bodywork, and music. I understand that each of these will be included in the session and are integral parts of the retreat experience.
2. INFORMED CONSENT AND ASSUMPTION OF RISK AND RELEASE OF LIABILITY
This Informed Consent and Assumption of Risk and Release of Liability is material to the event Contract and is incorporated herein by reference. I, the client certify that I am of adequate physical condition to participate in physical exercise and all activities involved in the retreat. I certify that I am aware of the nature of this event and retreat, assume the full risk of participating in any sessions and activities during the retreat. I certify that I will disclose to Usamah Aissou and Spirasana and affiliates, contractors and/or employees/volunteers whenever suggested activities cause distress beyond my threshold. I certify that I will not hold Usamah Aissou and Spirasana and affiliates, contractors and/or employees/volunteers liable for any physical injury, whether minor, severe, or otherwise that may result from this event and any retreat activities. I certify that I assume all responsibility for my participation in the breathwork and Spinal Energetics session and the retreat.
3. I consent that I am in good physical health and do not suffer from any condition that would hinder my participation in any activity by Usamah Aissou and Spirasana. These Activities include, but are not limited to, physical movement, breath, meditation, release of emotions, touch, bodywork, Spinal Energetics, and music. I understand that my participation in all offerings held by Usamah Aissou and Spirasana and affiliates, contractors and/or employees/volunteers during the retreat is under my own volition and I am fully aware of the risks involved.
4. I hereby release my image should photos or videos be taken during retreat activities that may later appear on future media, for websites, social, or any press purposes, with the same terms as previously stated.
5. Indemnity. In addition to the previously stated terms, I agree to irrevocably release and waive any and all claims I have now or may have hereafter against the facilitators of this session or retreat, including Usamah Aissou and Spirasana and affiliates, contractors and/or employees/volunteers. I indemnify and hold harmless Usamah Aissou and Spirasana and affiliates, contractors and/or employees/volunteers from any injuries, illnesses, and the like, experienced as the result of participating in this breathwork and Spinal Energetics session or any activities during the retreat.
6. I have fully read, fully understand, and agree to the above terms of this Liability Waiver Agreement, including specific provisions for retreat participation. I am signing this agreement voluntarily and recognize that my signature serves as a complete and unconditional release of liability to the greatest extent allowed by law in both session and retreat contexts.
7. Entire Agreement. This document reflects the entire agreement between the Parties and reflects a complete understanding of the Parties with respect to the subject matter. This Contract supersedes all prior written and oral representations. The Contract may not be amended, altered, or supplemented except in writing signed by both Usamah Aissou and Spirasana.
8. Legal and Binding Contract. This Contract is legal and binding between the Parties as stated above. This Contract may be entered into and is legal and binding all over the world. The Parties each represent that they have the authority to enter into this Contract.
9. Severability. If any provision of this Contract shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. If the Court finds that any provision of this Contract is invalid or unenforceable, but that by limiting such provision it would become valid and enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited.
10. Applicable Law. This Contract shall be governed and construed in accordance with the laws of the state where the event is held, without giving effect to any conflicts of laws provisions.
BY SIGNING BELOW & TURNING UP TO THE SESSION OR RETREAT, I, THE CLIENT, ACKNOWLEDGE HAVING READ AND UNDERSTOOD THIS CONTRACT AND AGREE TO THE TERMS AND CONDITIONS CONTAINED IN THIS CONTRACT. THE CLIENT SHOULD NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME YOU SIGN IT.
ACKNOWLEDGMENT
I AM IN GOOD PHYSICAL AND MENTAL HEALTH AND DO NOT SUFFER FROM ANY MEDICAL CONDITION THAT COULD CONSTITUTE A DANGER TO MYSELF OR OTHERS AS A RESULT OF MY PARTICIPATION IN THE ACTIVITIES, AND I ACCEPT TO PARTICIPATE IN THE ACTIVITIES FREELY.
I acknowledge that I have read and completely understand the terms of the release, that I am legally of sound mind, and voluntarily agree to the terms and conditions stated above for both individual sessions and retreat participation.