Sound Healing Waiver Page | Breathe Out Collective

Full Name *

Email Address

Sound Healing Participation Waiver

This checklist supports self-awareness, safety, and informed participation in sound healing sessions. Answer honestly — this is about choosing the right level of support for your experience.

I understand that Sound Healing is not a replacement for medical, psychological, or psychiatric care.I am willing to listen to my body and communicate any discomfort during or after the session.I feel able to self-regulate with support if strong emotions or sensations arise.I understand that sound healing may produce powerful vibrational, emotional, or energetic responses, and I am free to rest or opt out at any time.

Medical Considerations

Please check any that apply and discuss with the facilitator before participating:

Please list any sound sensitivities, hearing conditions, or additional notes:

Mental & Emotional Health Considerations

History of severe anxiety or panic attacksDissociation or depersonalizationBipolar disorderSchizophrenia or psychotic episodesPTSD or complex traumaCurrently experiencing emotional instability or crisis

If you checked any boxes above:

I have spoken with a healthcare or mental health professionalI understand that my sound healing experience may need to be modifiedI am open to a gentle or grounding-focused experience onlyI understand the facilitator may recommend additional support or referral

Acknowledgment of Participation

I understand that I am voluntarily participating in a sound healing session offered through Breathe Out Collective, and that my participation is entirely of my own free will.I acknowledge that sound healing is a powerful vibrational practice that may involve singing bowls, gongs, drums, and other instruments. Effects may include deep relaxation, emotional release, altered states of awareness, or temporary physical sensations.I understand that this experience may bring up physical sensations, emotional responses, or shifts in awareness, and I consent to engaging with these as part of the process.

Health Disclosure

I affirm that I have fully and honestly disclosed any relevant medical, psychological, or physical conditions that may impact my ability to safely participate in sound healing. I understand that withholding health information may put me at risk.I understand it is my sole responsibility to consult with a qualified healthcare provider before participating if I have any concerns. Breathe Out Collective does not provide medical advice.

Assumption of Risk

I fully understand and acknowledge that participation in sound healing carries inherent risks, including but not limited to:

Dizziness or lightheadedness
Emotional release or overwhelm
Temporary physical discomfort or fatigue
Altered states of consciousness or awareness
Re-emergence of stored memories or emotions

I knowingly and willingly assume all risks associated with my participation in sound healing, and accept full responsibility for any harm or adverse effect that may result.

Release of Liability

In consideration of being permitted to participate in sound healing sessions offered by Breathe Out Collective:

I hereby release, waive, and discharge Breathe Out Collective, its owner, facilitators, instructors, contractors, and any guest practitioners from any and all liability, claims, demands, or causes of action arising out of my participation in any sound healing activities, whether caused by negligence or otherwise.I acknowledge that I am solely responsible for my own health and well-being before, during, and after the session. I agree not to participate if I am feeling unwell.

Personal Responsibility

I may stop, pause, or modify my participation at any time
I am encouraged to listen to my body and honor my limits
I am responsible for communicating any discomfort or concerns to the facilitator

Accuracy of Information

I confirm that all information I have provided is true, accurate, and complete to the best of my knowledge.

Consent

By signing below, I acknowledge that I have read, understood, and agree to the terms outlined in this waiver. I voluntarily consent to participate in sound healing sessions at Breathe Out Collective.

Signature

Signature (type full name) *

Printed Name *

Date *