Welcome! If you are not familiar with Breathwork I encourage you to read this blog post by Dr. Zandra Palmer that discusses what happens to our physiology during it. I will also go over some elements in our session before we begin the practice. 

Signature of the waiver below is required prior to attending your first Breathwork session with Shanna.

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breath & Create waiver

This form must be completed in order to participate in a session.

You will receive a zoom link to the session upon completing this form.

I, the participant, (“Releasor/Participant”), understand that in participating in consultations, coaching sessions, breathwork sessions, breathwork immersions and trainings, (collectively referred to as “Activities”) offered by Shanna Shrum of The Compassionate Creative Collective (“Releasees/Facilitator”), I agree to the following:

SERVICES & DISCLOSURE.

I understand that breathwork and Activities offered by Releasees are designed to enhance quality of life and support holistic wellbeing, and are not intended to constitute medical advice or any substitution for medical care. I understand that Activities are not intended to be relied upon for diagnosis or treatment in relation to any health problem, and services of the Facilitator do not replace the care of licensed professionals.

MEDICAL DISCLAIMER & CONTRAINDICATIONS.

I understand that breathwork and Activities may involve strong connected breathing, which can result in dramatic experiences accompanied by strong emotional and physical responses. I understand that I may find the Activities physically, emotionally, or mentally stressful, and that breathwork and Activities are not safe under certain medical conditions and not advised for persons with a history of cardiovascular disease or prior heart attack, high blood pressure, use of prescription blood thinners such as Coumadin, epilepsy or seizures, glaucoma, osteoporosis, severe asthma, bipolar disorder, schizophrenia, dissociative disorders, history of significant trauma, and during pregnancy.

I hereby state that I am not pregnant, and if any of the above conditions apply to me, I will advise the Facilitator prior to participation. I understand that the Facilitator is not qualified to evaluate my fitness for involvement in the Activities, and that I am fully responsible for seeking medical help to treat all symptoms that are present before and after the Activities. I hereby state that I am physically and mentally fit to participate in Activities, and understand that it is solely my responsibility to seek professional support after Activities if I feel unstable mentally or emotionally. I knowingly waive any claim I may have against the Releasees for injury or damages that I may sustain as a result of participating in Activities.

RISKS.

I understand and acknowledge that the Activities in which I am participating in bear certain known inherent risks that contribute to the unique character of these Activities, and that Facilitator cannot eliminate, alter, or control these inherent risks. 

I hereby expressly and specifically assume the risk of injury or harm, and agree that my involvement in Activities is purely voluntary, and that I elect to participate in spite of the Risks.

LIMITATION OF LIABILITY.

By using Shanna Shrum’s services and purchasing Activities, I accept any and all risks, foreseeable or non-foreseeable, arising from such transaction. I agree that Facilitator will not be held liable for any damages of any kind resulting or arising from including but not limited to; direct, indirect, incidental, special, negligent, consequential, or exemplary damages happening from participation in Activities or use of materials provided.

 

INDEMNIFY & HOLD HARMLESS.

By clicking “Register,” “Purchase,” “Buy Now,” or any other phrase on the purchase button, entering my credit card information, or otherwise enrolling, electronically, verbally, or otherwise in Activities, I, in my personal name and on behalf of my relatives, heirs, legal representatives, and assigns, agree at all times to release, indemnify and hold harmless Releasees, as well as their affiliates, employees, students, joint venture partners, successors, assignees, and licenses, as applicable, from and against any and all claims, causes of action, damages, liabilities, costs, and expenses, including legal fees and expenses, arising out of or related to Activities. I knowingly and freely assume all risks, both known and unknown, even if arising from the negligence of the Releasees or others, and assume full responsibility for my participation in Activities.

Thanks for submitting!