Release Form/Health Declaration - Rise Temple Breathwork Journey's


If you suffer or have suffered from any serious health issues or the ones listed below, please consult your doctor before participating in an active breathing journey to avoid health risks:

  • Cardiovascular problems, abnormally high blood pressure, aneurysms, epileptic seizures/other seizures in the past, pregnancy, recent surgery, upcoming surgery, glaucoma (condition involving the optic nerve), osteoporosis (decreased bone density), if you suffer from challenges and/or Mental and psychiatric symptoms and/or are taking strong psychiatric medications, suffering from psychosis or paranoia, bipolar and/or an untreated or inadequately supported mental illness.

  • If you suffer from asthma, bring an inhaler and update the breathing guide before you participate.
  • The above list is not exhaustive, therefore please update Amanda Jane if you have any unusual health condition that does not appear in the above list you, and you may need to consult a doctor before participating in a breathing session that activates the sympathetic nervous system.
  •  I hereby declare and undertake that I am in good health in every respect in accordance to the above health risks, and I understand and undertake that if at any time I am not healthy and pose the risks as stated I will not be able to participate in the scheduled breathing activity.
  • My statement and confirmation herein constitutes my willing agreement to participate in the breathing session. I understand that a breathing journey is not a cure for any health condition.
  •  I know and acknowledge that Amanda Jane is not a doctor or a psychiatrist, or a health expert, and I therefore release her from any responsibility, costs and/or damages that may arise from my participation in the above activity. In addition, I understand that the proposed activity is not intended for the treatment and/or diagnosis of any medical condition, whether physical, mental or otherwise.
  • I participate freely and undertake the responsibility for all the consequences, known and unknown, that may arise from a breathing journey.
  •  By filling out and sending the form, I confirm that I have read all of the above and I agree to continue freely.
  • Mandatory fields are marked with an asterisk *


 

By signing below, I acknowledge that I have read the above warning and agree to proceed with full responsibility, and understand that I have waived certain rights by signing and signing this release of liability freely and voluntarily without any external influence in.

If you have any questions with regards to this waiver and your breath work journey. Please add in the question section below.

Email *
Your name: *
Email address: *
Mobile phone: *
Gender/What you identify as/Pronoun (answer as you wish) *
Age *
Anything important I should know/Questions
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