For the purposes of this Release and Waiver, the term “Releases” shall refer to any or all of:
1. Name of Practitioner: Online or In person Participant.
2. Name of organization, company or legal entity: BREATHE ON and Jolene
d’Entremont.
3. The heirs, assigns, successors, employees, volunteers and/or
associates of (Name of practitioner) and/or (name of company, organization or legal entity.
I, the participant, (“the Releasor/attendee”), understand and acknowledge that the discussions, consultations and breathwork session session(s), teaching(s), videos(s) I have, the Releasees:
● are not intended to replace any relationship I have with my medical doctor and/or primary health care provider(s);
● are not intended to constitute medical advice or any substitution for medical care;
● are not intended to be relied on for prescriptions, recommendations, diagnosis or treatment in relation to any health problem or disease.
● I realize that THE BREATHWORK is a powerful experiential tool for accessing my own inner healing and can greatly intensify my transformational process. Through the process of guided breathing and music, I will embark on a healing journey. Because this process can bring up intense emotions and strong physical experiences, I have been advised that it is not recommended for those with certain types of cardiovascular problems, epilepsy, recent surgery, pregnancy, or psychosomatic, mental health, other physical limitations, or emotional problems.
I understand that if I am taking any medications or have any medical conditions such as, but not being limited to: schizophrenia, bi-polar, epilepsy, heart conditions, or pregnancy, that I must advise the facilitator/s. I also understand that even though I have been accepted as a participant, I am responsible for any consequence resulting from any and all session(s).
I certify that I have consulted a health professional regarding any condition physical, mental or emotional that could interfere with my judgment, or affect my health in any way during or after any and all session(s). I understand and acknowledge that I am responsible for consulting my health care provider or doctor in case I have or suspect to be suffering from a health problem.
I understand the stories or testimonials presented before or during the session do not constitute a warranty, guarantee, or prediction regarding my experience during or after the session. BREATHE ON AND JOLENE D’ENTREMONT AND facilitators make no warranty, guarantee, or prediction that I will experience any particular state of awareness or consciousness during or after any and all session(s), nor does it make any representation that I will experience any particular outcome on an issue. In the instance of a group processes I may voluntarily reveal personal information, in doing so I understand that and hereby waive my rights of privacy and confidentiality.
I further understand that my participation in any and all session(s) is not intended to create nor does it establish a client-practitioner relationship or any other type of therapeutic or professional relationship between me and BREATHE ON and Jolene d’Entremont.
I understand and acknowledge that by participating in any and all session(s), I do it at my own risk. It is with this understanding that I voluntarily sign this waiver. Since any and all session(s) is experiential and the extent of any and all session(s) risks and benefits are not fully known, I agree to assume and accept full complete responsibility for any known and unknown risks associated with my participation in any and all session(s), including any physical injury, psychological or emotional effects, death, loss, or property damage.
I agree and understand any and all session(s) may be filmed, photographed and/or recorded and that BREATHE ON and Jolene d’Entremont and/or facilitators shall have all rights in and to such film, photographs and/or recording, including the copyright therein. The copyright shall include, but not be limited to, the right to use, re-use, publish, and re-publish and otherwise reproduce, modify, and display any such film, photograph and/or recording for educational and promotional purposes, including without limitation, audiotapes, audio CDs, DVDs, websites, video, or film or any other form of recorded images. I grant BREATHE ON and Jolene d’Entremont the right, without compensation to myself, to film, photograph and/or record you while participating in any and all session(s) and I waive any right which I now have or may have hereafter in any such film, photograph and/or recording. I agree to not record by audio, video, photographic or any other means, any portion of any and all session(s).
In my personal name, that of my heirs and assignees, I exonerate and totally and indefinitely release the relinquishers of any suit, complaint, declaration, damage, cost and / or expense of any kind (that any such prosecution, complaint, declaration, damage, cost and/or expense is caused by the passive or active negligence of the Releasees or otherwise) in connection resulting from any discussion, consultation any and all session(s) I had.