Client Intake & Waiver

Welcome to The Focused Breath.

This form helps us support your breath, body, movement, recovery, and overall wellness safely and effectively.

Please complete the following intake and waiver prior to participating in services, classes, workshops, coaching, breathwork, yoga, meditation, or related wellness activities offered through The Focused Breath.

The following questions help ensure practices are modified appropriately and safely for your individual needs.

I understand that services provided through The Focused Breath may include breathwork, breathing exercises, meditation, mindfulness practices, yoga, movement, relaxation techniques, nervous system regulation strategies, and wellness education.

I understand that participation in these activities may involve physical movement, changes in breathing patterns, breath retention exercises, emotional responses, relaxation responses, and nervous system activation or downregulation.

I acknowledge that possible experiences may include, but are not limited to:

• Lightheadedness
• Dizziness
• Tingling sensations
• Emotional release
• Temporary discomfort
• Increased awareness of stress or emotions
• Physical fatigue or soreness

I understand that participation is voluntary and that I may stop or modify participation at any time.

I understand that these services are educational and wellness-based in nature and are not intended to diagnose, treat, cure, or replace medical or psychological care.

I understand that I am responsible for communicating any discomfort, limitations, injuries, or concerns during participation.

I, the undersigned Participant, desire to participate in classes, sessions, workshops, or activities involving breathwork, yoga, meditation, and related wellness practices (collectively, the "Activities") offered by The Focused Breath, LLC, and Blake Boyer ("Released Parties").

Acknowledgment and Understanding of Risks I understand and acknowledge that the Activities involve physical exertion, stretching, balancing, deep breathing techniques (including pranayama/breathwork), guided meditation, and other practices that may be physically and/or emotionally demanding. These Activities carry inherent risks, including but not limited to:

● Muscle strains, sprains, tears, joint injuries, or aggravation of pre-existing conditions
● Dizziness, lightheadedness, fainting, hyperventilation, or emotional release
● Heart strain, breathing difficulties, or other physical/psychological effects
● Injury from falls, improper form, or environmental factors
● Aggravation of medical conditions (e.g., high/low blood pressure, pregnancy, asthma, epilepsy, anxiety disorders, heart conditions, back/neck issues, recent surgery, or any other physical/mental health concerns)

I understand that breathwork and intense meditation can sometimes lead to strong emotional or physical responses, and these practices are not a substitute for medical treatment, therapy, or professional mental health care.

Assumption of Risk I voluntarily assume all risks associated with participating in the Activities, whether known or unknown, and even if arising from the negligence (but not gross negligence or willful misconduct) of the Released Parties.

Release and Waiver of Liability In consideration of being permitted to participate in the Activities, I hereby, on behalf of myself, my heirs, executors, administrators, successors, and assigns:
1. Release, waive, discharge, and covenant not to sue the Released Parties from any and all liability, claims, demands, actions, causes of action, damages, costs, expenses (including attorneys' fees), or losses of any kind arising out of or related to any injury, illness, death, property damage, emotional distress, or other loss I may sustain as a result of participating in the Activities, including those caused by negligence (but excluding gross negligence or intentional acts).
2. Agree to indemnify and hold harmless the Released Parties from any claims brought by me or on my behalf, or by anyone else arising from my participation.

Health Representation I represent and warrant that:
● I am in good physical and mental health and have no medical conditions that would prevent safe participation.
● I have consulted a physician regarding any concerns and have received clearance if needed.
● I will immediately inform the instructor of any changes in my health or any discomfort during class.
● I will listen to my body, modify or stop any practice if needed, and not push beyond my limits.

Medical Emergency Consent In the event of injury or medical emergency, I authorize the Released Parties to seek emergency medical treatment on my behalf and agree to be responsible for all related costs.

Voluntary Participation My participation is voluntary, and I understand this is a full and unconditional release of liability to the maximum extent permitted by law.

I have read this entire document carefully, understand its terms, and sign it of my own free will without duress.

From time to time, photos or videos may be captured during classes, workshops, or events for educational or promotional purposes.

By signing below, I acknowledge that I have read, understood, and voluntarily agree to the terms outlined in this intake and waiver form.