Welcome!
___ 

To get started, please scroll down to complete the general medical and release of liability form.
 
To prepare for your breathwork practices:
  • You may want to have headphones, eyemask/eye covering, journal & pen
  • Create your space with intention 
  • Set up your space so you can sit or lay down comfortably
  • Breathwork cannot be done while driving

Welcome!
___ 

To get started, please scroll down to complete the general medical and release of liability form.
 
To prepare for your breathwork practices:
  • You may want to have headphones, eyemask/eye covering, journal & pen
  • Set up your space so you can sit or lay down comfortably
  • Breathwork and meditation cannot be done while driving

General Medical Questionnaire

Thank you for taking your time to complete this form. Please note, if you a pregnant you must get cleared by your doctor before practicing breathwork. 

Release of Liability

As the client, and in consideration for my participation in breathwork sessions. I agree that my participation is entirely voluntary and that I assume any risk associated with participation. Any actions or lack of actions, taken by me, the client, of such advice is done so solely by choice and responsibility, and any harm, injury, or loss that may occur to me or my property as a result of my participation of breathwork session(s) with Present by Nature LLC, is neither the responsibility nor liability of Hungry for Happiness, LLC dba Pause Breathwork (“PBW”) or trained Facilitator. My signature below acknowledges that trained Facilitator is an independent contractor of PBW, and PBW has no control over and assumes no responsibility for the acts or omissions of trained Facilitator.I understand that I may be photographed or videotaped for quality training purposes. We promise to take utmost care of any footage of you and will pledge that this footage will only be used for internal training purposes and not distributed in any way, within the boundaries of the law that applies to this agreement. If for whatever reason we wish to use footage outside of training purposes, we will inform you and get your permission first. By signing this agreement, you agree to these terms. I understand that breathwork is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care or substance abuse treatment, and I will not use it in place of any form of therapy. I recognize that breathwork requires emotional, physical, and mental effort, exertion, and behavioral experimentation, on my part, which may cause physical, mental or emotional injury. I fully acknowledge and take full responsibility for all the risks involved. I understand that it is my responsibility to consult with my health care provider prior to participating. In the event that I am injured, I agree to assume any financial obligation, either through my personal health insurance, or through some other means, for any medical costs I incur.  Facilitator assume no responsibility for any medical expenses, injury, or damage suffered by me in connection with the use of any facilities or services. IN CONSIDERATION OF MY PARTICIPATION, I HEREBY GENERALLY RELEASE, AND PROMISE TO INDEMNIFY, DEFEND, AND HOLD HARMLESS the Facilitator, AND THEIR RESPECTIVE AGENTS AND EMPLOYEES (THE “RELEASE PARTIES”), FROM ANY LIABILITY WHATSOEVER. I will reimburse the Facilitator for any damages, reasonable settlements and defense costs, including attorney’s fees, that they incur because of any such claims made against them. I agree that the terms of this agreement, including the indemnification obligations in this paragraph, will be binding on my estate, and my personal representative, executor, administrator or guardian will be obligated to respect and enforce them. This RELEASE does not extend to claims for gross negligence, intentional or reckless misconduct, or any other liabilities that applicable law does not permit to be excluded by agreement.I agree that the purpose of this agreement is that it shall be an enforceable RELEASE OF LIABILITY AND INDEMNITY as broad and inclusive as is permitted by New York law. I agree that if any portion or provision of this agreement is found to be invalid or unenforceable, then the remainder will continue in full force and effect. I also agree that any invalid provision will be modified or partially enforced to the maximum extent permitted by law to carry out the purpose of the agreement.I understand that this is a contract that affects my legal rights, and I have read and understood this form and all its contents, and I voluntarily agree to the terms and conditions stated above.