Waiver for Breathwork Masterclass Gathering 2022

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Your details

Name*

Emergency Contact

In case of emergency during the gathering, we will reach out to the person below.

Intentions

This is mainly for your own awareness, but also good for us to know.
Waiver of Responsibility

During the gathering we will be working with several healing modalities, namely plant medicines, cold(ice bath), heat(sauna) & of course breathwork. The modalities we will be doing come with risks. It could bring up feelings of fear, anger, frustration, confusion or other negative psychological effects, and in exceptional cases can lead to psychosis or schizophrenia. The use of these substances (and therefore joining this gathering) is in all cases entirely at your own risk. The gathering organizer, ceremony holder, affiliated partners and companies can in no way be held liable for the consequences of joining this gathering and taking part in its modalities.

Contra Indications

The gathering should not be joined in the following cases (participant has the right to request a refund, but be sure to reach out to us first):

  • Pregnancy or breastfeeding
  • history of schizophrenia or other psychological disorders
  • addiction (such as alcohol), an addiction history
  • currently under treatment by a doctor or psychologist
  • use of medication
  • Inability to look at oneself or take responsibility.
Answer the following questions

If you have to answer "no" to any of these questions, fill in "no" and reach out to us.

I am aware of the risks involved in attending this ceremony and of the contraindications.*
I declare that I am in good health and currently not on any (prescription) medication.*
I declare that I am not currently being treated by a physician, psychiatrist, or psychologist, or have been treated for addiction, schizophrenia, or other psychological disorders.*
I declare that I am not pregnant or breastfeeding at this time.*
I declare that I am well able to look at myself, to take responsibility for my own choices, interpretations and (mental) process.*
I declare that I will never hold the ceremony organizer, ceremony holder, affiliated partners and companies liable for both the anticipated and unforeseen risks or consequences of attending this ceremony.*
I understand that this statement is binding as a contract, is not for informational purposes only, and I declare that I have signed this document of my own free will.*