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I understand that this session may involve any of the following breathwork practices:

● Conscious connected breathing

● Circular breathing

● Breath holds

● Slow rhythmic breathing

● Somatic movement and emotional release

During this type of work, you may experience physical sensations (e.g., tingling, lightheadedness, temperature changes), emotional responses (e.g., crying, anger, joy), or energetic shifts. These are common and can be part of the healing process.*

I understand that breathwork may not be recommended and diagnosis of the following MUST be discussed and disclosed prior to booking:

● High or uncontrolled blood pressure

● Cardiovascular disease or recent heart surgery

● Diagnosed aneurysms

● Epilepsy or history of seizures

● Bipolar disorder, schizophrenia, or psychosis

● Use of antipsychotic medication

● Severe PTSD

● Recent physical injuries or surgeries

● Pregnancy

● Severe asthma

● Detached retina or glaucoma

*

By participating in this breathwork session, I confirm that I am not under the influence of alcohol, recreational drugs, or any substance that may impair my ability to consent*

I understand that emotional responses may arise during breathwork and agree to manage my own well-being accordingly. I will communicate if I experience distress beyond my personal threshold.

 I am fully responsible for my own physical, emotional, and mental health before, during, and after the session, and for communicating my needs and boundaries.*

 I release and indemnify Asia Jackson and any affiliated facilitators from liability for claims of injury, illness, damage, or distress that may arise during or after the session.

I understand that this work may involve non-invasive, trauma-informed touch, if applicable. I understand that I have the right to say no to touch or any activity and may stop participating at any time.

I agree to communicate my boundaries, needs, discomfort, or concerns as best as I can during the session.*

By signing below, I confirm that I have read, understood, and agree to the Intake Waiver Participation Agreement and Assumption of Risk outlined above.*