This liability waiver and release extends to Breathwork Northwest together with all owners, partners, employees and contractors.

Medical Form

Holotropic Breathwork® is intended as a personal growth experience and should not be looked upon as a substitute for psychotherapy. Holotropic Breathwork® can involve intense experiences accompanied by very strong emotional and physical release. This workshop may not be appropriate for pregnant women, or for persons with cardiovascular problems, severe hypertension, severe mental illness, recent surgery or fractures, acute infectious illness, or epilepsy.

The answers to the following questions will assist your facilitators in serving you and will be kept strictly confidential.

Please answer all questions as completely as possible.  If you are uncomfortable explaining any "Yes" answers on this form, enter "Please contact me" in the description box and a facilitator will call you.

BREATHWORK NORTHWEST PARTICIPANT CONTRACT RELEASE, WAIVER, AND INDEMNITY OF LIABILITY AGREEMENT

1. This Agreement is made and entered into under the laws of the State of Washington and the United States and shall be interpreted, governed and enforced under and pursuant to these laws.
2. Participant agrees that should an action be brought against Breathwork NW or its agents for any reason whether to enforce the terms of this agreement or on some other basis, that all disputes between Participant and Breathwork NW or its agents will be litigated in King County, Washington and Participant waives any rights he/she may have in litigating in any other jurisdiction.
3. Participant has filled out the Medical Information Form and certifies that he/she does not have any medical or physical conditions which would impair or affect his/her ability to engage in any activities or which would cause any risk of harm to Participant, other participants and/or Breathwork NW or its agents or otherwise endanger Participant’s health while attending a Breathwork NW Program. Participant further agrees that it is Participant’s responsibility to maintain the accuracy and contemporaneousness of the Medical Information Form. Breathwork NW will assume that Participant’s Medical Information Form is correct until Participant files an updated or corrected form. The medical information is fully incorporated by reference within this agreement.
4. Participant is aware that certain activities he/she may engage in during the Program are physically, emotionally and mentally stressful. Participant agrees to assume full responsibility for his/her own physical, emotional and mental health and hold harmless Breathwork NW and its agents from any physical, emotional and/or mental damage that may be attributed to Breathwork NW or its agents. Participant further holds harmless Breathwork NW and its agents from any and all loss, liability, injury, damage or cost which may arise out of or in connection with participation in the Program.
5. Participant understands and agrees that he/she is attending the Program at the discretion of Breathwork NW and can be dismissed from the Program at any time without being informed of the reason for dismissal.
6. Participant waives, releases and discharges any and all claims, rights and/or causes of action which he/she now have or which may arise out of or in connection with participation in the Program as well as which may arise out of or in connection with Participant’s attendance and/or participation in the activities associated with the Program. Therefore, under no circumstance will Participant prosecute or present any claim for personal injury, property damage or any other cause of action against Breathwork NW or its agents.
7. This agreement is binding on Participant’s heirs, assignees, dependents, personal representatives and estate.
8. No oral representations, statements or inducements have been made to Participant to cause them to enter into this agreement.
9. At the choosing of Breathwork NW any claim or controversy that arises out of or relates to this agreement, or the breach of it, may be settled by arbitration in accordance with the rules of the American Arbitration Association. Such arbitration shall be binding upon the parties and Judgment upon the award rendered may be entered in any court with jurisdiction.
10. Should Breathwork NW or its agents be successful in bringing an action to enforce the terms hereof or successful in defending itself from a suit brought by Participant, Breathwork NW or its agents shall recover all costs and expenses incurred in such action, inc. reasonable attorneys’ fees.
11. Should any provision of this Agreement be held invalid or illegal, such illegality shall not invalidate the remainder of this Agreement. In that event, this Agreement shall be construed as if it did not contain the invalid or illegal part, and the rights and obligations of the parties shall be construed and enforced accordingly.

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