RELEASE, WAIVER, AND INDEMNITY OF LIABILITY AGREEMENT

Breathwork9, LLC is the “Organizer.” The Organizer and its members, managers, officers, employees, and agents, including but not limited to K Mari Castle, Ph.D., are referred to as “Organizer Parties.” After review of this agreement, I hereby consent to the performance of Breathwork9 and other procedures that are within the scope of practice of Grof® Holotropic Breathwork by K Mari Castle, Ph.D, along with any assisting facilitators.

1. This Agreement is made and entered into under the laws of the State of Florida and the United States and shall be interpreted, governed and enforced under and pursuant to these laws.

2. Participant has filled out the Medical Information Form and certifies that he/she does not have any medical or physical conditions which would impair or affect his/her ability to engage in any activities or which would cause any risk of harm to Participant, other participants and/or any participating Organizers Parties, or otherwise endanger Participant’s health while attending a Grof® Holotropic Breathwork session. Participant further agrees that it is the Participant’s responsibility to maintain the accuracy and updates of the Medical Information Form. Organizer Parties will assume that Participant’s Medical Information Form is correct until Participant files an updated or corrected form. The medical information provided is fully incorporated by reference within this agreement and is clearly agreed to below.

A) Grof® Holotropic Breathwork is not recommended for pregnancy. Participant will notify the Organizing Parties if pregnant. If Participant becomes pregnant, she will notify the Organizing Parties immediately. B) Grof® Holotropic Breathwork is contraindicated for people with a history of epilepsy and/or seizure. If Participant has a history of epilepsy or seizures, he or she will notify the Organizing Parties and understand that it is not recommended to do this modality with this medical history. C) Grof® Holotropic Breathwork is not recommended for any serious heart diagnosis. If Participant has any medical heart condition that he or she believes is contra-indicated for holotropic states of consciousness, he or she will notify the Organizing Parties.

3. Participant is aware that Grof® Holotropic Breathwork is not recommended for mental diagnosis such as Schizophrenia, Bipolar Disorder and/or severe psychosis resulting in long-term medical hospital or long-term psychiatric care. Participant understands that contra-indications may exist for the anticipated activities if Participant is or has been suffering medical or psychological/psychiatric conditions requiring professional care; and that the activities described can also trigger suppressed traumas. Hence, Participant represents that he/she is not currently, nor for the preceding five years been, under the treatment and care of a physician or therapist for any condition, nor has he/she been diagnosed for any condition or currently taking any medication or mind altering substance, except as expressly disclosed in the Medical Information Form; and failure to disclose same constitutes a basis for disqualification and dismissal from the Program, and shall be deemed a knowing and voluntary waiver and complete release of any claim against Organizer Parties as more specifically described in Section 8 and related provisions herein.

4. Participant is aware that certain activities he/she may engage in during the Program are physically, emotionally and/or mentally stressful and may include, but are not limited to, deeper and faster breathing. Participant has been made aware that faster and deeper breathing over a prolonged period can cause dizziness, palpitations, tingling/numbness of the extremities, carpopedal spasms [involuntary contractions of the muscles of the hands and feet], ringing/roaring in the ears, clouded/distorted vision, perceptual distortions, and feelings of lightness, astonishment and/or euphoria. Physical Activities will also include twisting and turning while prostrate and other exertions not normally engaged in by Participant. Loud music is also used with the described activities.

5. Participant understands that during the actual breathwork session, he or she can slow down breathing to alleviate any uncomfortable sensations that may lead to believe this process is adversely affecting Participants health. Further, Participant is encouraged to let one's inner healer/wisdom guidance through a deeper and faster breath for healing any imbalances in overall health. Participant is aware and understands that in some cases a facilitator will perform bodywork to assist in clearing any blockages of energy in the physical body. Participant has been made aware that if this bodywork becomes uncomfortable, he or she can use the word “stop” to end the bodywork. Participant understands that if any other words are used besides the word “stop”, the Organizing Parties may not understand to stop the process. Participant further understands the right to refuse any physical touch at all during a holotropic session and will notify the Organizing Parties.

6. Participant has been informed that Grof® Holotropic Breathwork is a generally safe method of treatment, and that it generally leaves one in a state of profound relaxation. Participant understands that a holotropic experience may continue beyond the actual session and he or she may be left unsettled or can improve other areas in my life. Participant has been notified of the profound effects holotropic states of consciousness can have on a person’s psyche and that it is suggested to take care of his or her overall health just prior to the Grof® Holotropic Breathwork session and for as many days as necessary (typically 3-7 days) following the session.

7. Participant does not expect the Organizing Parties to be able to anticipate and explain all possible risks and complications of a Grof® Holotropic Breathwork session, and will rely on K Mari Castle, Ph.D to exercise judgment during the course of time in the workshop and trust that what she thinks at the time, based upon the facts then known, will be for Participant's best interest. Participant acknowledges that potential benefits of Grof® Holotropic Breathwork have been discussed and potential outcomes explained. Participant understands that results are not guaranteed, and that participation in a holotropic state of consciousness may be determinant upon the mindset, quality of health, and quantity of non-ordinary experiences including Grof® Holotropic Breathwork sessions to significantly influence the outcome and results.

8. Participant understands that all records will be kept confidential and will not be released without written consent, unless otherwise required by law. Participant agrees to assume full responsibility for his/her own physical, emotional and mental health and hold harmless Organizer Parties from any physical, emotional and/or mental damage that may be attributed to the Program or any participation therein. Participant further holds harmless Organizer Parties from any and all loss, liability, injury, damage or cost which may arise out of or in connection with participation in the Program.

9. Participant understands and agrees that he/she is attending the Program at the discretion of Organizer and can be dismissed from the Program at any time without being informed of the reason for dismissal. Participant also understands and confirms his/her agreement that Organizer Parties make no guarantee of any type of experience or any experience whatsoever [see also the Medical Release Form, which is incorporated herein by this reference].

10. Participant waives, releases and discharges, any and all claims, rights and/or causes of action against Organizer Parties which he/she, and/or his/her agents, representatives, guardians, successors, assigns, heirs, children, and next of kin, may now have, or which may arise out of or in connection with participation in the Program, as well as which may arise out of or in connection with Participant’s attendance and/or participation in the activities associated with the Program. Therefore, under no circumstance will Participant prosecute or present any claim for personal injury, property damage or any other cause of action against Organizer Parties or against participating Breathwork9 and/or Grof® Holotropic Breathwork Facilitators and Apprentices. This release includes, without limitation, any personal injury, death, or property damage caused by the active or passive negligence of any of the Organizer Parties. Participant bears sole responsibility for any loss. See also Medical Release Form, which is incorporated herein by this reference.

11. This agreement is binding on Participant’s heirs, assignees, dependents, personal representatives and
estate.
12. No oral representations, statements or inducements have been made to Participant to cause them to enter into this agreement.
13. At the choosing of Organizer Parties and/or any participating Facilitator or Apprentice, any claim or controversy that arises out of or relates to this agreement, or the breach of it, may be settled by arbitration in accordance with the rules of the American Arbitration Association. Such arbitration shall be binding upon the parties and Judgment upon the award rendered may be entered in any court with jurisdiction.
14.. Should any Organizer Party and/or any participating Facilitator or Apprentice be successful in bringing an action to enforce the terms hereof or successful in defending itself from a suit brought by Participant, Organizer Party and/or any participating Facilitator and/or Apprentice shall recover all costs and expenses incurred in such action, including reasonable attorneys’ fees.
15. Should any provision of this Agreement be held invalid or illegal, such illegality shall not invalidate the remainder of this Agreement. In that event, this Agreement shall be construed as if it did not contain the invalid or illegal part, and the rights and obligations of the parties shall be construed and enforced accordingly. I have read this agreement, which includes the Medical Release Form, incorporated herein by this reference, and understand it contains release of all claims language for injuries and damages. I voluntarily sign my name evidencing acceptance of the provisions of this agreement. If English is not my native language I have either studied enough English to be able to read and understand this agreement, or I have had this agreement explained to me in my native language.
I have read this agreement, which includes the Medical Release Form, incorporated herein by this reference, and understand it contains release of all claims language for injuries and damages. I voluntarily sign my name evidencing acceptance of the provisions of this agreement.