BREATHWORK LIABILITY AND WAIVER

I, (First and Last name), voluntarily agree to enter into this Release of Liability Waiver and Assumption of the Risk (“Waiver”) on (Date). I recognize that I have chosen to participate in today’s or any Breathwork activities and events which include active breathing and meditation practice for the purpose of improving physical and emotional stability (“Breathwork”).

I recognize that today’s Breathwork may result in moderate-to-vigorous physical activity associated with the breathing pattern practice. The Breathwork may also result in physical side effects which may include but are not limited to the temporary numbing of the mouth and other body parts, tingling sensation, muscle contraction, clenched hands, dizziness, nausea, acute pain, release of tears, laughter, among other temporary physical experiences. The Breathwork may also result in temporary emotional volatility.

I understand that Breathwork is not advised for persons who are pregnant or who might be pregnant, nor is it advisable for persons with a history of suffering cardiovascular disease, seizures, high blood pressure (not controlled by medication), glaucoma, osteoporosis, severe mental illness or other recent physical injuries or surgery. I understand and take full responsibility to consult with a physician prior to and regarding my participation in today’s and any Breathwork practice.

I hereby affirm that I am in good physical, psychological and emotional condition and do not suffer from any known disability or condition which would prevent or otherwise limit my full participation in today’s or any Breathwork practice. In addition, I am fully aware of the risks and hazards connected with the participation in this Breathwork and I hereby elect to voluntarily participate in this Breathwork.

I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, THAT MAY BE SUSTAINED BY ME, OR LOSS OR DAMAGE TO PROPERTY OWNED BY ME, AS A RESULT OF PARTICIPATION IN THIS PROGRAM. I hereby unconditionally and irrevocably release, waive, discharge, and covenant not to sue Helene Wilkinson or Aesthetics by Helene LLC, her employees, agents, consultants, independent contractors, volunteers or any other person or entity associated with the Breathwork activities and experiences offered (collectively referred to as “RELEASEES”), from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury (including, but not limited to, death) that may be sustained by me, or to any property belonging to me, while participating in today’s or any Breathwork practice, or while on or upon the premises where the event is being conducted including, but not limited to, any claims arising under negligence. I understand and agree that this Release of Liability, Waiver and Assumption of Risk Agreement extends to and includes any and all damages, injuries, and claims which I do not anticipate or know to exist and to any and all damages, injuries, or claims which may develop in the future, and I hereby expressly waiver and relinquish any and all rights under any law or statute to the contrary. Furthermore, this Waiver includes an express waiver of Civil Code Section 1542, which states: “A general release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor.” To the fullest extent allowed by law, I agree to defend, indemnify, and hold harmless Helene Solo and Aesthetics by Helene LLC and her RELEASEES for all costs and expenses, including but not limited to all legal fees incurred by Helene Solo and her RELEASEES in defending any claim brought against any or all RELEASEES by any releasing party including myself. It is my expressed intent that this waiver and release shall bind any and all members of my family including, but not limited to, my spouse, if I am alive, and my heirs, assigns, and personal representatives, if I am deceased. It is also my expressed intent that this waiver and release shall also be deemed a full release, waiver, discharge, and covenant not to sue insofar as my aforementioned family members, heirs, assigns, and personal representatives are concerned. I hereby further agree that this waiver and release shall be constructed in accordance with the laws of the State of Maryland. I further acknowledge that I was advised to consult an attorney to review this Waiver. In signing this Waiver, I acknowledge and represent that I have read and understand the foregoing and hereby sign it voluntarily as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I hereby execute this waiver and release for valuable consideration, intending to be bound by the same.

• CANCELLATION POLICY

I accept no refunds will be issued. I accept that Helene can offer me the possibility to attend
another session as long as the session is not sold out.