Somatic Breathwork Group Session
Breathwork with Jon - Sign Up/Waiver
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Name: *
Email Address: *
Location of Group Session *
Date of Session *
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Send $35 - $55 (sliding scale):

ZELLE: Jonathan Orsini 203.988.2302 or
VENMO: @Jon-Orsini
*
Required
Preparing for the Session:

1) Please arrive early for a prompt start (no late entry)

2) Dress comfortably

3) Bring a yoga mat or blanket to lay on

4) Layers that are easy on/off or a blanket as temperature may vary during the experience

5) Avoid a heavy meal 2 hours prior to the session

6) Water

7) Journal & Pen
*
Required

Waiver

I acknowledge that Somatic Release BreathworkTM is a deep and powerful process. I have notified the practitioners of any physical injuries, mental or psychological conditions I have. I engage in this experience willingly and take full responsibility for my own physical, mental and emotional experiences during and after the session. 

Contraindications

Somatic Release BreathworkTM is intended as a personal growth experience and should not be looked upon as a substitute for psychotherapy. It is not appropriate for pregnant women, for persons with cardiovascular problems, including angina or heart attack, high blood pressure, glaucoma, retinal detachment, osteoporosis, history of seizures, stroke, major psychiatric conditions, recent surgery, acute infectious illness or epilepsy. If you have any doubt about whether you should participate, please consult with your primary care physician. Persons with asthma should bring their inhaler and consult with their primary care physician. 

Release

I hereby release and hold harmless Breathwork Guide Jon Orsini from any and all results that arise during or from the Somatic Release Breathwork. I waive all rights under law regarding the same. I or my representative(s) agree to full release and hold Breathwork Guide Jon Orsini harmless from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s). 

Cancellation/Refund Policy

There are no refunds. If you need to reschedule you must do so with a minimum of 24 hours notice. With less than 24 hour notice the session will not be rescheduled or refunded.

Attestation of Good Health

*
Required
After receiving this form and payment I will send you an email confirmation before the session with specific location details, etc.

I am looking forward to seeing you there!

Much Love,

Jon

Jon Orsini
Certified Breathwork Guide
Kripalu Center Faculty
Insta: @jonorsini
YouTube: @BreathworkwithJon
breathworkjon@gmail.com
jonorsini.com
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