It is compulsory to attend all sessions of the course. Use of recording devices is prohibited. I understand that any benefits derived from this course depend upon the extent of my participation. I therefore accept full responsibility for the outcome and I willingly agree to follow all instructions and participate fully.  I also agree that I will not disclose the content of this course to anyone.I shall also refrain from taking and/or sharing photographs and/or screenshots and/or video recordings of other participants during the program without obtaining their prior written consent. I further agree that I will not attempt to instruct others in any of the techniques used in the course until such time as I receive personal training from Project Welcome Home Troops or IAHV Canada. By entering my name and date below I agree to the above.

With the information I have provided on this form and during the interview I will disclose any health conditions before the course begins. I further acknowledge that, if I am diagnosed with schizophrenia; schizoaffective, bipolar, or seizure disorders; pregnancy; and/or am a new mother or recent surgical patient, certain portions of this course may be unsuitable for me and I will consult with my medical provider before registering. The power breath program is an immersive experience, and can be intense, you may or may not experience sensations in the body, strong emotions, intrusive memories, and other experiences in some cases, knowing this I agree to participate in the program. If I feel for any reason that I need to stop the program, I am free to remove myself from the program. By entering my name and date below I agree to the above.

As a condition for, and in consideration of the right to participate in any way in any program provided by the International Association for Human Values Canada (the Organization), I, for myself, my personal representatives, and family, agree as follows:

Organizational programs involve risk of personal injury which may be caused by my own actions or inactions, the actions or inactions of others participating in the programs, the conditions in which the programs take place, or the acts or omissions of others. (“Risks”);
I fully accept and assume all Risks and all responsibility for losses, costs, and damages I may incur as a result of my participation in Organization programs.
I hereby release, discharge, and covenant (agree) not to sue or hold responsible in any manner whatsoever, the Organization, its affiliates, administrators, directors, agents, officers, members, volunteers, and employees, other participants, officials, owners and lessees of premises on which the programs are conducted (the “Released Parties”), from all liability, claims, demands, losses, or damages on my account caused, or alleged to be caused, in whole or in part by the acts, omissions or negligence of any of the Released Parties and I further agree that if, despite this release and waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Released Parties, I will indemnify, save, and hold harmless each of them from any litigation expenses, attorney fees, loss, liability, damage, or cost which may be incurred as the result of such claim.

By agreeing to this Waiver, I acknowledge that I am at least 18 years of age, have carefully read and fully understand this waiver of liability, assumption of risk, indemnity agreement and release, understand that I have given up substantial rights by agreeing to this waiver, have agreed to it freely and without any inducement or assurance of any nature, and intend this to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect. By entering my name and date below I agree to the above.

Instructions: Below is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully and click the appropriate bubble to indicate how much you have been bothered by that problem in the last month. Please use the following scale:  Not at all (1) A little bit (2) Moderately(3) Quite a bit(4) Extremely(5) Answers will be kept confidential.