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Breathwork Waiver
Please complete the below questions before your breathwork session
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Email *
First Name *
Last Name *
Emergency Contact Name & Phone Number  *
Date *
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YYYY
I have done Breathwork with Jenn at least once before *
I know what Conscious Connected Breathing is and how to do it. *
I do not have any of the following: heart condition, am newly pregnant, PTSD, COPD, high/very low blood pressure with a fainting history, recently undergone major surgery or have been diagnosed with bipolar disorder or schizophrenia. 

If one of the above applies please advise Jenn before the session.
 *
I understand and acknowledge that by participating in this session, I do so at my own risk. Since the session is experiential in nature and the extent of the 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 the session, including any physical injury, or psychological or emotional effects. *
In-person sessions only- I consent to the use of appropriate/supportive touch during my session in order to support my own process of healing, of which Jenn will inquire/check in about before we begin and I acknowledge that it is my responsibility to let Jenn know my boundaries around touch if I have specific ones.
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Do you have any injuries or areas of your body that are sensitive or prone to tension/tightness/clenching that I should know about?
Do you have any allergies I should be aware of? Other health conditions? (diabetes, epilepsy etc)
Do you have any food restrictions/preferences/allergies we should know about?
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