Release form to be completed by all Participants

In consideration of being admitted to participate in the activities of the Holotropic Breathwork™ (“HB”) workshop I hereby agree as follows:

I have decided to participate in the workshop with full understanding of the potential risks to my health and safety, both physical and psychological. These risks include possible exposure to the Covid 19 virus or other illnesses or diseases that may easily be passed in close group settings. As a participant, support person, or facilitator of Holotropic Breathwork™, I understand that I will be in close contact with other people in ways that make exposure to viruses or other illnesses more likely than in other settings.

I have filled out the Medical Form and certify that I do not have any medical or physical conditions :
which would impair or affect my ability to engage in the workshop;
which would cause any risk of harm to myself, other participants and the facilitators;
or otherwise endanger my health while attending the workshop.

In order to create a safe container for all participants in the upcoming workshop:
I will avoid being exposed to a large number of people during the days before the workshop;
I will not come to the workshop if I have disease symptoms.

The information in the Medical Form is fully incorporated by reference within this agreement.

By signing this waiver form I understand that I may face challenging emotional and/or physical experiences and I agree to assume full responsibility for my own physical, emotional and mental health before, during and after the workshop. I declare that neither I, my heirs or legal representative(s) will thereby not hold the facilitators or Remedy (the venue) responsible for any injuries or emotional stress incurred.

I understand and agree that the facilitators of this Holotropic workshop can dismiss me from the workshop at any time if they assess my presence becomes a risk to myself or others.

Your name, signature and date (mandatory)

Your email address (mandatory)