Breathwork Waiver | Breathe Out Collective

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Breathwork Participation Waiver

This checklist supports self-awareness, safety, and informed participation. Answer honestly. This is not about exclusion — it's about choosing the right level of support.

I understand that Breathwork is not a replacement for medical, psychological, or psychiatric care.I am willing to listen to my body and slow down, pause, or stop if needed.I feel able to self-regulate with support if emotions or sensations arise.I understand that intense or activating Breathwork is optional and not required.

Medical Considerations

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

Please list any additional allergies to scents or essential oils:

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 Breathwork practice may need to be modifiedI am open to gentle or regulation-based breath practices onlyI understand the facilitator may recommend additional support or referral

Acknowledgment of Participation

I understand that I am voluntarily participating in a breathwork session, workshop, or journey offered through Breathe Out Collective, and that my participation is entirely of my own free will.I acknowledge that breathwork is a powerful somatic practice that may involve conscious connected breathing, altered breathing patterns, extended breath holds, and significant emotional, physical, or energetic release. Effects may include but are not limited to tingling, altered states of consciousness, intense emotions, or temporary physical discomfort.I understand that this experience may bring up physical sensations, emotional responses, suppressed memories, or shifts in awareness, and I consent to engaging with these experiences as part of the process.

Health Disclosure

I affirm that I have fully and honestly disclosed any and all relevant medical, psychological, or physical conditions — including those listed in the Medical and Mental Health sections above — that may impact my ability to safely participate in breathwork. 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, conditions, or uncertainties about my suitability for breathwork. Breathe Out Collective does not provide medical advice.

Assumption of Risk

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

Dizziness or lightheadedness
Tingling or numbness in extremities
Temporary muscle cramping (tetany)
Emotional release or overwhelm
Physical discomfort or fatigue
Altered states of consciousness
Re-emergence of stored trauma or memories

I knowingly, voluntarily, and willingly assume all risks associated with my participation in breathwork, whether foreseen or unforeseen, and accept full responsibility for any harm, injury, or adverse effect that may result.

Release of Liability

In consideration of being permitted to participate in breathwork sessions, workshops, or journeys offered by Breathe Out Collective, I, the undersigned, hereby agree to the following:

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 that I may hereafter have for injuries, illness, damages, or death arising out of my participation in any breathwork activities, whether caused by negligence or otherwise.I acknowledge that I am solely responsible for my own health, well-being, and experience before, during, and after the session. I agree not to participate if I am feeling unwell or if my physical or mental condition may put myself or others at risk.

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

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 breathwork sessions at Breathe Out Collective.

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