
Liability Waiver
In consideration of participating in all the activities provided with all the facilitators at the Masters in Modalities at Miracle Manor Retreat, I acknowledge and agree to the following terms:
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Related to breathwork:
1. Breathwork can result in intense physical and emotional activity and release. This work is deeply
experiential. It may involve intense and energetic emotional release. Therefore, it is not
recommended to particulate, and I agree to notify Susan, prior to the session, if I have any of
the following conditions:
(a) history of cardiovascular disease, including angina or heart attack,
(b) high blood pressure,
(c) use of a pacemaker,
(d) glaucoma,
(e) retinal detachment,
(f) osteoporosis,
(g) significant recent physical injuries or surgery,
(h) mental illness or seizure disorders,
(i) for persons using medications, including psychotropic and/or narcotics
(j) personal or family history of aneurysms
2. Pregnant women are required to consult with and obtain approval from their primary care
physician, and notify Susan, prior to the session. Persons with asthma are required to consult
with and obtain approval from their primary care physician, and notify Susan, prior to the
session.
3. I understand that there exists a risk of physical, mental, psychological or emotional injury or
death from, or related to, the Breathwork session. I fully acknowledge that I am voluntarily
participating in the activities with knowledge of the danger involved. I agree to work with and
comply with the guidance and instruction provided by Susan and with the stated and customary
guidance and norms of participation in the activities. If I observe any unusual hazard or feeling in
my body during my presence or participation, I will immediately remove myself from
participation in the activities and bring such to the attention of the Susan or the nearest official.
4. I acknowledge that Susan and the Releasees (defined below) are not physicians, psychologists,
therapist, or health care professionals, and the activities being offered are not intended to treat
or diagnose any illnesses, disease or disorders, whether physical, mental, psychological or
emotional.
5. The facilitators cannot prevent you or others from being exposed to, contracting, or spreading COVID-19 while utilizing any of the modalities. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize said services and/or enter participate in the breathwork session and other activities, you may be exposing yourself to and or increasing your risk of contracting or spreading COVID-19.
6. I hereby RELEASE, INDEMNIFY, AND HOLD HARMLESS Susan, and her employees, independent contractors, agents, representatives and facility where the retreat is being conducted
(“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, including physical, mental, psychological or emotional injuries or damages. I further RELEASE, INDEMNIFY, AND HOLD HARMLESS Releasees, from any ANY LOSS or DAMAGE to PERSON or PROPERTY, of any kind, whether arising from the negligence of all the facilitators or otherwise. I waive any claim I have to Releasees now or in the future. Such release and waiver shall extend to my heirs or estate.
7. The terms of this Release and Waiver shall be governed by California law.
8. To the extent that any portion, clause or aspect of this Release and Waiver is found to be invalid,
void or unenforceable, all other portions, clauses or aspects of this Release and Waiver shall
remain in full force and effect.
9. I give Elements in the desert, Miracle Manor and the facilitators permission to use pictures and video for advertising and teaching purposes.
10. I understand none of the facilitators are physicians and do not give medical advice, and nothing should be taken as such. I will seek medical direction as needed for my well being.
11. I have read this release of liability and assumption of risk agreement fully, understand its terms and I have has the opportunity to consult with an attorney or, at my sole discretion, elected not to do so.