Name *

First Name

Last Name

Are you pregnant?: *

Yes

No

Considerations *

I understand that Conscious Connected Breathwork is an active breathing practice that catalyzes episodes of emotional reactivity and can result in cathartic emotional releases and accessing of previously unconscious memories. The practice may produce changes to my normal physical, mental, emotional, and psychological states including, but not limited to, elevated heart rate, temperature fluctuations, muscular tension, remembering stressful or traumatic unconscious experiences, emotional releases, and non-ordinary states of consciousness. I as the breather accept for accountability for my own healing process. I am aware that anything that may arise from this breathing practice is part of my own self healing. I have informed the Conscious Connected Breathwork facilitators and assistants of any medical conditions that I may have that require special attention while practicing Conscious Connected Breathwork. These include, but are not limited to, glaucoma, detached retina, recent injuries or surgeries, low blood pressure, and pregnancy. I hereby consent to the participation in the Conscious Connected Breathwork process and I agree to and do hereby indemnify, save harmless and release the host, the Breathwork facilitators, or any other parties indicated or implied from any and all claims, actions, costs, expenses and demands of whatsoever kind, in respect to loss, damage, bodily injury or death to persons, including the myself, or to property, which may arise out of or in connection with the my participation in the Conscious Connected Breathwork process, unless such loss is occasioned by or attributable solely to the gross negligence of the facilitators. I agree that all exercises and activities are undertaken at my own risk. I acknowledge that the facilitators hereby reserve the right to request that I withdraw from the Conscious Connected Breathwork process at any time if, in the sole opinion of the facilitator, I am not acting in a responsible manner or displaying appropriate conduct, or in the event that my behavior is deemed to constitute a danger to the health, safety or well being of either myself or of other participants in the Conscious Connected Breathwork process.

Yes

No

Would you like to be added to my newsletter where you'll receive guided breathwork sessions you can do on your own, reflections, and musings inspired by the seasons?

Yes

Not right now