Request edit access
SEIKRID Breathwork - Release of Liability
Hi SEIKRID Breathwork is an embodiment experience that takes you out of your thinking mind and into your body’s electrical network. It lets you release unneeded energy within this network caused by repeating thoughts, feelings, and old narratives by discharging it out through your body.

Your nervous system is the electrical network of your being. Over time, unresolved trauma or chronic stress causes dis-regulation of this network. When dis-regulated, difficulties in your personal or professional life arise. When you heal trauma and stress, you heal the electrical network of your nervous system. When you heal the nervous system, you heal the emotional self so your authentic self can emerge.

SEIKRID Breathwork employs circular connected breathing coupled with rhythmic music to produce a cathartic emotional release. This release may be in the form of moving, shaking, yelling, crying, or laughing. Using the breath, you will engage your innate ability to heal and sweep out any defenses, blockages, restrictions, or pains that hold you back from who you are and how you want to show up in this world.

You will create a private, comfortable place to lie down on a yoga mat with 1 blanket recommended under your body and one blanket for warmth. Have a water bottle with a lid, and a journal for your ceremony integration.

*Contraindications:
SEIKRID Breathwork is intended as a personal growth experience and should not be looked upon as a substitute for psychotherapy. It is not appropriate for persons with:
-cardiovascular problems, including angina or heart attack
-high blood pressure
-glaucoma
-retinal detachment
-osteoporosis
-history of seizures
-stroke
-major psychiatric conditions
-recent surgery, acute infectious illness or epilepsy
-persons who are pregnant

**If you have any doubt about whether you should participate, please consult with your physician(s).
**Persons with asthma should bring their inhaler and consult with their physician(s).
Email *
Occupation
First Name *
Last Name *
Mobile Number *
By signing up for SEIKRID Breathwork with Jessica, you agree to these terms: *
Required
Please expand here if you have any physical injuries, mental or psychological conditions to share with me. If none, please type "none". *
Release: I have chosen to participate in a session using the SEIKRID Breathwork modality. My choice has been voluntary and I may terminate my session at any time. I understand that there is no assurance that I will feel better and that emotions may be evoked that will be upsetting in nature. I understand the potential risks of participation and hereby agree to release and hold harmless Jessica Sears (Boyle) and her facilitators of SEIKRID Breathwork from any and all legal responsibility or liability for outcomes experienced as a result of this session utilizing SEIKRID Breathwork. I or my representative(s) agree to fully release and hold Jessica Sears (Boyle) and facilitators of Breathwork harmless from and against any and all claims, liability, or damages - arising out of or in connection with my session(s). Type your full legal name and date below for e-signature. By CLICKING the box "Yes, I confirm", I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. *
Required
I hereby expressly waive and release any and all claims, now known or hereafter known, against the Jessica Sears (Boyle) or her Company BOLD LLC (dba SEIKRID), and its officers, directors, employees, agents, affiliates, shareholders/members, successors, and assigns (collectively, "Releasees"), on account of injury, death, or property damage arising out of or attributable to my participation in the Activities. I covenant not to make or bring any such claim against Jessica Sears (Boyle) and the Company BOLD LLC (dba SEIKRID) or any other Releasee, and forever release and discharge Jessica Sears (Boyle) the Company and all other Releasees from liability under such claims. I shall defend, indemnify, and hold harmless the Company and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including attorney fees, fees and the costs of enforcing any right to indemnification under this Agreement, and the cost of pursuing any insurance providers, arising out or resulting from any claim of a third party related to the Activities. By CLICKING the box "Yes, I confirm", I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE COMPANY.
*
Attestation of good health: I hereby confirm that I have read and understand the above information and attest that my general health is good to participate. But we I *
Required
I represent and warrant to Jessica Sears (Boyle) and Company BOLD LLC (dba SEIKRID) that I am at least eighteen (18) years of age, and I have full right, power, and authority to enter into this Agreement and grant the rights hereunder. I further represent and warrant to Company that I will provide only true and correct statements and other information in connection with this Agreement.
*
Photography and Videography: 

I hereby irrevocably permit, authorize, grant, and license Jessica Sears (Boyle) her Company BOLD LLC (dba SEIKRID) and its affiliates, successors, and assigns, and their respective licensees, advertising agencies, promotion agencies, and fulfillment agencies, and the employees, officers, directors, and agents of each and all of them ("Authorized Persons"), the rights to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use, and permit others to use my name, image,
likeness, and appearance, voice, professional and personal biographical information, and all materials created by or on behalf of Company that incorporate any of the foregoing ("Materials") in perpetuity throughout the universe in any medium or format whatsoever now existing or hereafter created, including but not limited to, in and on magazines, brochures and other print publications, electronic, magnetic, and optical media, motion pictures, television broadcast, cablecast, and satellite, home video and video on demand, radio broadcasts, display, point-of-sale, and other advertising and promotional materials, press releases, the internet and other digital transmission or delivery methods, mobile applications, on any platform and for any purpose, including but not limited to advertising, public relations, publicity, packaging, and promotion of Company and its affiliates and their businesses, products, and services, without further consent from or royalty, payment, or other compensation to me. Company shall be the exclusive owner of all rights, including copyright, in the Materials. I hereby irrevocably transfer, assign, and otherwise convey to Company my entire right, title, and interest, if any, in and to the Materials and all copyrights and other intellectual property rights in the Materials arising in any jurisdiction throughout the universe in perpetuity, including all registration, renewal, and reversion rights, and the right to sue to enforce such copyrights against infringers. I acknowledge and agree that I have no right to review or approve Materials before they are used by Company, and that Company has no liability to me for any editing or alteration of the Materials or for any distortion or other effects resulting from Company's editing, alteration, or use of the Materials, or Company's presentation of me. Any credit or other acknowledgment of me, if any, shall be determined by Company in Company's sole discretion. Company has no obligation to create or use the Materials or to exercise any rights given by this Agreement. To the fullest extent permitted by applicable law, I hereby irrevocably waive all legal and equitable rights relating to all liabilities, claims, demands, actions, suits, damages, and expenses, including but not limited to claims for copyright or trademark infringement, infringement of moral rights, libel, defamation, invasion of any rights of privacy (including intrusion, false light, public disclosure of private facts, and misappropriation of name or likeness), violation of rights of publicity, physical or emotional injury or distress, or any similar claim or cause of action in tort, contract, or any other legal theory, now known or hereafter known in any jurisdiction throughout the world (collectively, "Claims") arising directly or indirectly from the Authorized Persons' exercise of their rights under this Agreement or the production, exhibition, exploitation, advertising, promotion, or other use of the Materials, and whether resulting in whole or in part by the negligence of Company or any other person, covenant not to make or bring any such Claim against any Authorized Persons, and forever release and discharge the Authorized Persons from liability under such Claims. I  understand that Company is relying on this Agreement and will incur significant expense in reliance on this Agreement, and I agree that this Agreement cannot be terminated, rescinded, or modified, in whole or in part.
*
How did you hear about this event? *
If someone referred you to this session, please provide their name.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report