Breathe for Impact 2026 Registration Form

"Breathe for Impact" Registration Form

Please fill out this form carefully
Name*

VornameNachname
E-mail*
example@example.com
Mobile Number*
Format: (000) 000-0000.
Birth Date

DayMonthYear
Yes, it's amazing!No, it's the first time
Cardiovascular problemsAbnormally high blood pressureEpilepsy and seizuresPsychosis, Paranoia, BipolarRecent surgeryGlaucoma (eye pressure)PregnancyAsthma - please bring your inhalerI have no counter-indications
Liability Waiver
I have read and do accept the liability waiver
Yes, and nothing has changed.No
Date
Please sign
Is there anything else that you would like me to know?
Thursday, 9 April, 7pm - Theme: Freedom & ForgivenessThursday, 2 July, 7pm - Theme: Trust & Letting GoThursday 17 September, 7pm - Theme: Grief & CompassionThursday 3 December, 7pm - Theme: tbd
Please note that sessions are not transferable. If you book a session but are unable to attend, I am unable to offer a reimbursement.
Yes, please.No thanks!
Pay here*
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Breathe for Impact - 1 Session
145.00CHF Quantity

Zwischensumme

0.00CHF

Steuer

0.00CHF

Gesamt

0.00CHF
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"Breathe for Impact" Registration Form