Liability Waiver & Release Agreement

Vitkovich Integrative Services LLC

Facilitator: Shane Vitkovich

 

This Liability Waiver & Release Agreement (“Agreement”) applies to all breathwork, somatic, and integrative wellness services provided by Vitkovich Integrative Services LLC (“Company”) and Shane Vitkovich (“Facilitator”).

By signing below, you (“Client”) agree to the following terms:

 

 

 

1. VOLUNTARY PARTICIPATION
 

 

I understand that participation in breathwork sessions is entirely voluntary. I may stop, pause, or discontinue the session at any time. The Facilitator may also end the session if they believe it is unsafe to continue.

 

 

 

2. NATURE OF BREATHWORK SERVICES
 

 

I understand that breathwork may include guided breathing exercises, somatic awareness, emotional release, and reflective practices.

 

I understand that breathwork is not psychotherapy, medical treatment, a diagnostic tool, or a substitute for professional mental health or medical care. The Facilitator is not acting as a medical provider or therapist.

 

 

 

3. POTENTIAL RISKS
 

 

I understand breathwork can produce physical, emotional, or psychological responses, including but not limited to:

 

dizziness or lightheadedness
tingling or numbness
muscle tension or cramps
emotional release (crying, anger, sadness)
resurfacing of memories or trauma
temporary altered states of awareness
 

 

I acknowledge that certain medical or psychological conditions may be contraindicated for breathwork.

 

 

 

4. CONTRAINDICATIONS
 

 

I agree not to participate if I currently have or have had:

 

severe asthma
cardiovascular conditions (including high blood pressure)
seizures or epilepsy
pregnancy
recent surgeries or injuries
bipolar disorder, psychosis, or schizophrenia
use of alcohol or drugs within 24 hours
 

 

I affirm I have disclosed all relevant conditions to the Facilitator.

 

 

 

5. CLIENT RESPONSIBILITY
 

 

I agree to:

 

communicate any discomfort
stop the session if overwhelmed
participate from a safe physical environment (for virtual sessions)
take full responsibility for my emotional and physical well-being
 

 

 

 

6. NO GUARANTEE OF RESULTS
 

 

I understand that breathwork does not guarantee specific outcomes.

 

 

 

7. RELEASE OF LIABILITY
 

 

In exchange for participating in breathwork services, I release, waive, and forever discharge Vitkovich Integrative Services LLC and Shane Vitkovich from all claims related to:

 

physical or emotional injury
psychological reactions
aggravation of existing conditions
accidental harm
any outcome resulting from my participation
 

 

 

 

8. ASSUMPTION OF RISK
 

 

I knowingly assume all risks associated with breathwork practice.

 

 

 

9. HOLD HARMLESS & INDEMNIFICATION
 

 

I agree to indemnify and hold harmless the Company and Facilitator from any and all claims, damages, or expenses arising from my participation, except in cases of gross negligence or intentional misconduct.

 

 

 

10. CONFIDENTIALITY
 

 

All personal information is confidential except when disclosure is required by law (harm to self, harm to others, abuse, or court order).

 

 

 

11. EMERGENCY CONTACT
 

 

I agree to provide an emergency contact who may be reached if needed.

 

 

 

12. JURISDICTION
 

 

This Agreement is governed by the laws of the State of Texas.

 

 

 

13. SEVERABILITY
 

 

If any section of this Agreement is found invalid, the remaining sections remain enforceable.

 

 

 

14. ACKNOWLEDGMENT & SIGNATURE
 

 

By signing below, I confirm that:

 

I am 18 years of age or older
I have read and understand this Agreement
I sign voluntarily without coercion