Please select if you have been hospitalised for any of the following:(Required)
Are you taking any medications that will effect you today? If so, please specify:(Required)
Are you currently in therapy of a support group?(Required)
Have you ever attempted or seriously considered suicide?(Required)
I hereby confirm that I read and understood the above information and have answered all questions completely and honestly, and have not withheld any information. My general health, other than as noted is good. I will not use alcohol or recreational drugs during this experience.I agree to not to hold the Breath Sanctuary, as well as the teachers of the breath work experiences, and assistants against all loss, damage, liability or expense arising out of, or in connection with anything owned or controlled by the Breath Sanctuary, or resulting from any acts, failure to act, or negligence of the Breath Sanctuary. The Breath Sanctuary is not liable for any slips, falls or injuries while on the premises of the breath work or ice bath experience. The Breath Sanctuary are not liable for any physical, medical or emotional experiences that may occur, however please notify someone immediately should something happen during the experience. I agree that use of the premises, facilities and equipment of the Breath Sanctuary is accepted by me at my own risk, and that the Breath Sanctuary is absolved and discharged from all liability for any loss or damage I may incur of my personal property.
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