BREATHWORK

RELEASE FORMS

Consent Form:

1. Introduction: This form outlines your participation in our guided breathwork session, aiming to enhance mindfulness.

2. Session Description: You will participate in a guided breathwork exercise lasting approximately 10-20 minutes. This session will be recorded and may be broadcasted.

3. Session Purpose: The purpose is to explore the effects of breathwork on well-being, during the podcast and potentially in public broadcasts.

4. Potential Effects: You may experience sensations like lightheadedness, tingling, or emotional release. These effects are typically brief. Guidance will be provided throughout.

5. Confidentiality and Public Sharing: The session will be recorded for the podcast. The final edited version may be shared publicly. By signing, you consent to the recording and public sharing of the session.

6. Voluntary Participation: Participation is voluntary. You may withdraw at any time.

7. Consent: By clicking below, you confirm you understand and agree to participate as described.

Name

First Name

Last Name

Date

MM

DD

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Email

I consent

This form should be signed and dated by the interviewee (or their parent/legal guardian if under 18) prior to the podcast interview.

Medical Disclosure Form:

Name

First Name

Last Name

Date

MM

DD

YYYY

Email

This form should be signed and dated by the interviewee (or their parent/legal guardian if under 18) prior to the podcast interview.

1. Health Conditions:

Please list any health conditions, especially those like respiratory or cardiovascular issues, recent surgeries, or psychological conditions that might affect your participation in a breathwork session.

2. Medications:

List any medications you are taking that could influence your ability to safely participate in the session.

3. Doctor's Contact:

If relevant, provide the contact details of your primary care physician or specialist.

4. Consent:

By clicking submit, I confirm that the medical information provided is accurate and authorize its use to ensure my safety during the breathwork session.

I consent

Liability Waiver:

1. Acknowledgment of Risk: I acknowledge that participating in a breathwork session involves inherent risks, including but not limited to physical injury or psychological stress. I have read the description of the session and understand what it will involve.

2. Waiver of Liability: By signing this waiver, I release Jeyda Deyna from Toronto Breathwork and any instructors or facilitators from all liability for any injury, loss, or damage connected to my participation in the breathwork session, whether arising from the ordinary negligence of the entities or persons released or otherwise.

3. Indemnification: I agree to indemnify and hold harmless the entities or persons mentioned above from any and all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my participation in the breathwork session.

4. Voluntary Participation: I confirm that my participation is voluntary, and I agree to comply with the stated and customary terms, conditions, and regulations during the session. I agree to wear appropriate attire and follow the instructions provided by the facilitator.

Name

First Name

Last Name

Date

MM

DD

YYYY

Email

I consent

By clicking submit, I acknowledge that the information provided is accurate and authorize its use to ensure my safety during the breathwork session.