breathwork liability 2025.pdf

GENERAL RELEASE OF LIABILITY

I, ________________________(First and Last name), voluntarily agree to enter into this Release of

Liability Waiver and Assumption of the Risk (“Waiver”) on _____________________(Dates). I recognize

that I have chosen to participate in Breathwork activities and events which include active breathing

pattern and meditation practice for the purpose of improving physical, emotional stability, as a Breathwork

facilitator.

I hereby affirm that I am in good physical, psychological and emotional condition and do not suffer from

any known disability or condition which would prevent or otherwise limit my full participation Breathwork

workshop.

I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE,

OR PERSONAL INJURY, INCLUDING DEATH, THAT MAY BE SUSTAINED BY ME, OR LOSS OR

DAMAGE TO PROPERTY OWNED BY ME, AS A RESULT OF PARTICIPATION IN THIS TRAINING.

I hereby unconditionally and irrevocably release, waive, discharge, and covenant not to sue Jennifer

Hercules (Hasta La Raiz LCSW), Kéo (91OntheRun LLC) their employees, agents, consultants,

independent contractors, volunteers or any other person or entity associated with the Breathwork

activities and experiences offered this weekend (collectively referred to as the “RELEASES”), from any

and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any

loss, damage, or injury (including, but not limited to, death) that may be sustained by me, or to any

property belonging to me, while participating in Breathwork, or while on or upon the premises where the

event is being conducted including, but not limited to, any claims arising under negligence. I understand

and agree that this Release of Liability, Waiver and Assumption of Risk Agreement extends to and

includes any and all damages, injuries, and claims which I do not anticipate or known to exist and to any

and all damages, injuries, or claims which may develop in the future, and I hereby expressly waiver and

relinquish any and all rights under any law or statute to the contrary. Furthermore, this Waiver includes an

express waiver of Civil Code Section 1542, which states:

In signing this Waiver, I acknowledge and represent that I have read and understand the foregoing and

hereby sign it voluntarily as my own free act and deed; no oral representations, statements, or

inducements, apart from the foregoing written agreements have been made; and I hereby execute this

waiver and release for valuable consideration, intending to be bound by the same.

I grant Hasta LA RAIZ LCSW and 91OntheRun LLC, its employees, representative and volunteers the

right to take photographs and footage of me and in connection with the Breathwork. I authorize Hasta LA

RAIZ LCSW and 91OntheRun LLC to use photographs and film of me with or without my name and for

any lawful purposes, including for purposes of publicity, illustration, advertising, and web content.

Name:___________________

Date: _________________

Signature: ________________