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YOUnity: Disclaimer
Breathwork Liability & Release waiver form
TERMS AND CONDITIONS:
1. The parties agree to the following terms and conditions:
a. client is engaging in breathwork services to be provided by Sophie Russell and affiliates, contractors and/or employees/volunteers
b. Client agrees to sign this informed Consent and Assumption of Risk and Release
Liability.
c. This event/retreat is not recommended and is not safe under certain medical conditions. I, that client, agree to inform provided by Sophie Russell 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. I will disclose any and all conditions, medical or otherwise, that may affect my ability to participate in this event, including the breath work session. 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, high blood pressure, pregnancy, recent physical injuries, fractures and surgeries. I confirm that I am not pregnant, nor do I have sever asthma, heart disease, diabetes, a mental illness, epilepsy/history of seizures and/or acute physical injuries. In the case of any of these conditions I understand participation will be revoked and I will not be allowed to participate in the event as a precaution to my health and well-being.
d. I understand that the event/retreat facilitators including their affiliates, contractors and/or employees/volunteers, do not diagnose illness or disease and this event does not
prescribe or replace medical treatment or pharmaceuticals.
e. As in the case of any physical activity, the risk of injury, is always and cannot be entirely
eliminated. If I experience any unusual pain or discomfort I will listen to my body and
discontinue the activities, and ask for support from the facilitator. I assume full
responsibility for any and all damages which may incur through the participation of the
event/retreat.
f. I understand that this event/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 event/retreat will result in me not being able to participate in the event. I will not be under the influence of drugs or alcohol whilst attending the event/retreat.
h. I confirm that I, alone, am responsible for deciding whether to participate in the
breathwork event and that I participate fully at my own risk.
I. I understand that this event includes breathwork and possibly trauma release which is
made up of physical movement, breathing, meditation, release of emotions, touch, body
work and sound. I understand that each of these will be included in this event.
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/retreat Contract and is incorporated herein by reference.
I, the client certify that I am of adequate physical condition to participate in physical
exercise. I certify that I am aware of the nature of this event and assume full risk of
participating in this event. I certify that I will disclose to Sophie Russell and affiliates,
contractors and/or employees/volunteers whenever suggested activities cause distress
beyond my threshold. I certify that I will not hold Sophie Russell, and affiliates, contractors and/or employees/volunteers liable for any physical injury, whether minor, severe, or otherwise that may result from this event and breathwork facilitated by Sophie Russell and affiliates, contractors and/or employees/volunteers. I certify that I assume all responsibility for my participation in this event and breathwork sessions.
3. I consent that I am good in physical health and of sound mind, and do not suffer from
any condition that would hinder my participation in any activity by Sophie Russell. These
activities include, but are not limited to, physical movement, breath, meditation, release of emotions, touch, bodywork and sound. I understand that my participation in all offerings held by Sophie Russell, and affiliates, contractors and/or employees/volunteers are strictly for entertainment purposes and understand any personal medical concerns are under the care of a medical professional. Any advice given is ultimately determined by my own free will and I release any liability to sue Sophie Russell, and affiliates, contractors and/or employees/volunteers. My participation in all activities, is confirmation that I am fully responsible for any and all risks, injuries or damages known or unknown without limitation. Additionally I am aware that Sophie Russell, and the location of the event is not a storage facility, if I leave items at the space after the event and do not contact them to pick up with 7 days they will be donated.
4. I hereby release my image should photos be taken in group activities that may later
appear on future media, for websites, social, or any press purposes. I give my permission
to use my name, likeness, image, voice, and/or appearance as such may be embodied in
any pictures, photos, video recordings, audiotapes, digital images, and the like, that I send to Sophie Russell and to her social media. I agree that anything I send, Sophie Russell she will have complete ownership of such pictures, etc, including the entire copyright, and may use them for any purpose. These uses include, but are not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisement, and any promotional or educational materials in any medium now known or later developed, including the Internet. I acknowledge that I will not receive any compensation, etc for the use of such pictures, etc. by completing this release, responding to this email, showing up for the event with Sophie Russell and entering any space held by them I agree to these terms.
5. Indemnity. I, the client agree to irrevocably release and waive any and all claims have I
have now or may have hereafter against the facilitators of this event, including Sophie
Russell and affiliates, contractors and/or employees/volunteers. I indemnify and hold
harmless Sophie Russell and affiliates, contractors and/or employees/volunteers for any
injuries, illnesses and the like, experienced as the result of this event including the
breathwork and sound sessions.
6. I have fully read and fully understand and agree to the above terms of this Liability and
Waiver Agreement. I am signing this agreement voluntarily and recognise that my
confirmation via the check box on the website, confirmation by email or by signature, serves as complete and unconditional release of liability to the greatest extended
allowed by law.
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 Sophie Russell.
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/ country/ county, where the event/retreat is held, without giving effect to any conflicts of laws provisions.
BY SIGNING BELOW AND TURNING UP TO THE EVENT/RETREAT/1:1 SESSION, I, THE CLIENT ACKNOWLEDGE HAVING READ AND UNDERSTOOD THIS CONTRACT AND THAT I, THE CLIENT ARE SATISFIED WITH 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.
ACKNOWLEDGEMENT I AM IN GOOD PHYSICAL AND MENTAL HEALTH AND DO
NOT SUFFER FROM ANY MEDICAL OR PHYSICAL CONDITIONS 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 states above.