ACTOFMERCY: Breathwork Participation, Disclaimer & Liability Waiver

To participate in ACT OF MERCY BREATHWORK, you are required to carefully read, acknowledge, and sign the following disclaimer and waiver prior to the session.

DISCLAIMER: Breathwork may not be suitable if you have any of the following conditions: Pregnancy, Detached Retina, Glaucoma, Uncontrolled High Blood Pressure, Cardiovascular Diseases (e.g., angina, heart attack, stroke), Aneurysm in the brain or abdomen, Uncontrolled thyroid conditions or diabetes, Asthma (please bring your inhaler), Epilepsy, Diagnosis of bipolar disorder, schizophrenia, or previous psychiatric condition, Hospitalisation for psychiatric/emotional crisis within the last 10 years, any other condition that could impair or affect your ability to participate in breathwork. This list is not exhaustive. If you are unsure, please consult your physician before beginning the breathwork session.*

I can confirm that I do not have the following conditions.

I have received or have medical clearance to participate in breathwork.*

Yes

RELEASE AND WAIVER
I, the participant ("the Releasor/attendee"), understand and acknowledge the following:

ACT OF MERCY BREATHWORK sessions are not intended to replace any relationship I have with my healthcare provider.
These sessions do not constitute medical advice, prescriptions, diagnosis, or treatment.
I am responsible for consulting a health professional regarding any conditions that may affect my participation.
I understand that my participation is at my own risk.
I acknowledge:
- My experience is unique and not guaranteed to match testimonials or others’ outcomes.
- These sessions do not establish a client-practitioner or therapeutic relationship.
- I take full responsibility for any known or unknown risks, including injury, psychological or emotional effects, or property damage.

In full consideration of the risk of injury while participating in ACT OF MERCY BREATHWORK and for the right to participate in the ACT OF MERCY BREATHWORK , I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily participate in this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the ACT OF MERCY BREATHWORK, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any kind of risks related to traveling to and from as well as participating the ACT OF MERCY BREATHWORK, which may include, but are not limited to, physical or psychological injury, pain, suffering, illness disfigurement, temporary or permanent disability, economic or emotional loss, mental illness and death.

I hereby release and discharge ACT OF MERCY BREATHWORK, its facilitators, employees, officers, and agents from any and all liability.

I acknowledge that I have carefully read this form and fully understand that it is a release of liability. I expressly agree to release and discharge the trainer or instructor from any and all claims or causes of action and I agree to voluntarily give up or waive any right that I may otherwise have to bring a legal action for personal injury or property damage.

I First NameLast Name hereby affirm that I have read, understood, and voluntarily agree to the above terms and conditions. I am voluntarily participating in the breathwork entirely at my own risk.

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