BREATHWORK GROUP WAIVER

I certify that I am a competent adult of at least 18 years of age or that if I am a minor under the age of 18, I understand that the consent of my parent/legal guardian/person having legal custody will also be required before treatment.

This Informed Consent is freely and voluntarily executed and shall be binding upon my spouse, relatives, legal representatives, heirs, administrators, successors and assignees.

I certify that I am in adequate physical, emotional and mental health to participate in a Breathwork session (If not, please specify below).

I acknowledge that should this information change, it is my sole responsibility to notify my Breathwork Facilitator.

I consent to and authorise Jacqui Sive to guide me in a Breathwork Session. This session may include energy healing, vocal toning, tapping, touch work and integration coaching support.

I understand that Jacqui Sive is not a licensed physician or functional breathing specialist and does not dispense medical advice or prescribe the use of any technique as a form of treatment for any physical or psychological conditions without the advice of a physician - either directly or indirectly.

As a Breathwork Facilitator, Jacqui Sive offers information of a general nature to help clients in their journey toward greater self-awareness, mind-body connection, emotional, mental, physical, and spiritual well-being and Jacqui Sive assumes no responsibility for how I (the client) may use this information.

Contraindications
Breathwork journeys are not recommended for people that are pregnant or that have a personal or family history of epilepsy, seizures, cardiovascular problems including angina or heart attacks, high blood pressure, aneurysms, glaucoma, retinal detachment, osteoporosis, or recent physical injuries, surgery or illness - particularly involving the brain, mouth, teeth, nose, throat, thyroid, immune system, lymphatic system, lungs, chest, ribs, spine, neck and/or reproductive organs.

Breathwork is not recommended for people with a personal history of serious mental illness, personality disorders, hospitalization for any psychiatric condition or emotional crisis, suicidality, psychosis, drug or alcohol addiction.

Side effects
Possible side effects may include dizziness, fainting, changes in body temperature, disorientation, tingling, carpopedal spasms, cramping, emotional breakthroughs, feeling physical, mental, energetic and/or emotional triggering and/or vulnerability.

I understand the nature of the service/session and any questions have been answered to my satisfaction. I understand that the session may involve risks of complications or injury from both known and unknown causes, and I freely assume these risks.

I understand that I have the right to refuse to participate in the session. No guarantee, warranty or assurance has been made to me as to the results that may be obtained. I certify the above information is correct to the best of my knowledge.

I agree to adhere to all safety precautions and regulations during my treatments/sessions. I will not hold Jacqui Sive or any associated companies or members of their staff responsible for any errors or omissions that I may have made in the completion of this form.

Please note that there will be loud music, and there may be people making loud noises. If you are sensitive to sound, please ensure you bring earplugs.

Breathwork is a powerful personal development and somatic practice, but it is not a replacement for medical care, psychological therapy, psychiatric treatment, or professional mental health support.

I am not a doctor, psychologist, psychiatrist, or licensed therapist. Breathwork sessions and coaching are designed to support self-awareness, emotional regulation, nervous-system capacity, and personal growth — not to diagnose, treat, or cure any medical or mental health condition.

If you are currently under the care of a medical or mental health professional, I encourage you to continue working with them alongside this work, and to seek professional support if you experience distress beyond your capacity.

Similarly, any business, financial, or life guidance shared is for educational and inspirational purposes only and should not be considered financial, legal, or professional advice. You are solely responsible for your decisions, actions, and outcomes.

By participating in breathwork and coaching, you acknowledge that you are choosing this work as a complementary support, and that you take full responsibility for your wellbeing, integration, and results.

By inserting your name below, you are signing this agreement electronically. You agree that your electronic signature is the legal equivalent of your manual signature, and you consent to be bound to this agreement.

PLEASE TICK THIS BOX TO ACKNOWLEDGE THAT YOU DO NOT HAVE ANY OF THE CONTRA-INDICATIONS, AND THAT YOU AGREE TO THESE TERMS + CONDITIONS:

Please add your emergency contact name and phone mumber below