CLIENT WAIVER, RELEASE OF LIABILITY, DISCLAIMER & ASSUMPTION OF RISK:
Breathwork, Yoga Nidra & Sound Bath
I understand and acknowledge that I am voluntarily participating in Breathwork, Yoga Nidra, Sound Bath, Yoga experiences, and related wellness services (“Services”) offered by Wyld Lotus Wellness and facilitated by Staci Hardy, in group and/or one-on-one, in-person settings. By signing this informed consent disclosure YOU ("CLIENT/PARTICIPANT") acknowledge that YOU understand what YOU are reading and agree to the following:
⸻
Nature of Services
YOU understand and agree to engage STACI HARDY ("COACH/FACILITATOR/INSTRUCTOR") to provide certain services which include the following holistic practices and techniques: Breathwork Techniques which Merriam-Webster defines as "conscious, controlled breathing done escpecially for relaxation, meditation, or theraputic purposes." Sound Bath, which is defined online as “a meditative experience that uses sound waves to promote relaxation and healing”, Meditation which Merriam-Webster defines as “a discourse intended to express its author's reflections or to guide others in contemplation”, Yoga, which Merriam-Webster defines as “a system of physical postures, breathing techniques, and sometimes meditation derived from Yoga." These Services are educational and experiential wellness practices and are not medical, psychological, or therapeutic treatment. YOU acknowledge that the COACH/FACILITATOR/INSTRUCTOR is not a physician, psychologist, psychiatrist, or licensed healthcare provider, and that these Services are not a substitute for medical or mental health care.
⸻
Breathwork
Although COACH/FACILITATOR/INSTRUCTOR is trained to perform the above Breathwork Services, COACH/FACILITATOR/INSTRUCTOR is not a licensed therapist, medical professional or other mental health care provider; in order to get medical advice, YOU must see a doctor. COACH/FACILITATOR/INSTRUCTOR does not represent the Services as any form of health care or psychotherapy, and despite research to the contrary, by law COACH/FACILITATOR/INSTRUCTOR may make no health benefit claims for said Services. However, these holistic practices are client-centered disciplines, in which COACH/FACILITATOR/INSTRUCTOR is highly trained to assisst YOU to accomplish YOUR goals, whatever they may be, using the Services described above. Nevertheless, the Services may not be regulated by any government or administrative body. COACH/FACILITATOR/INSTRUCTOR also does not provide any type of therapy services, despite the word “therapeutic” being included in the common definition of breathwork; the type of Services utilized by COACH/FACILITATOR/INSTRUCTOR are non-therapeutic in nature and are designed to supplement treatment and/or advice from licensed medical and mental health providers. Nothing in the Services shall be construed as a substitute for the treatment or advice of a doctor or other licensed medical professional.
⸻
Yoga Nidra & Sound Bath Meditation
YOU understand Yoga Nidra and Sound Bath Meditation sessions involve guided relaxation, meditation, and sound frequencies that may induce deep states of rest or emotional awareness. YOU acknowledge that YOU may stop participation at any time and adjust YOUR position as needed.
⸻
Yoga
YOU understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If YOU experience any pain or discomfort, YOU will listen to YOUR body, discontinue the activity, and ask support from the COACH/FACILITATOR/INSTRUCTOR.
⸻
Voluntary Participation
YOU understand participation is entirely voluntary. YOU agree to listen to YOUR body, honor YOUR limits, and take full responsibility for YOUR physical, emotional, and mental well-being during and after sessions.
⸻
Assumption of Risk
YOU knowingly, freely, and voluntarily assume all risks, known and unknown, associated with participation in these Services.
⸻
Release of Liability (Utah)
To the fullest extent permitted by Utah law, YOU have read and fully understand and agree to the above terms of this agreement on behalf of myself, or a minor for which YOU hold legal guardianship. YOU are signing this agreement voluntarily and recognize that YOUR digital/physical signature serves as complete and unconditional release of all liability to the greatest extent allowed by the law in the state of Utah. YOU hereby release, waive, discharge, and hold harmless Wyld Lotus Wellness, Staci Hardy, employees, contractors, assistants, and the venue from any and all claims, demands, damages, or causes of action arising out of or related to participation in these Services.
⸻
Results Disclaimer
YOU also acknowledges that COACH/FACILITATOR/INSTRUCTOR cannot and does not guarantee that implementation of the Services will provide YOU with an ideal resolution and/or perfect life. Throughout the Services, COACH/FACILITATOR/INSTRUCTOR may help Client think through and analyze decisions and assist YOU with finding YOUR own direction. The COACH/FACILITATOR/INSTRUCTOR may offer her opinions, but it is YOUR responsibility to make the final decision and choose the best option for YOURSELF. YOU also agree that YOU are solely responsible for any personal and/or professional decisions and indemnifies COACH/FACILITATOR/INSTRUCTOR from any liability regarding said decision. If, at any point during the Services, you feel any adverse effects from any of the Services and/or techniques defined above, you hereby agree to immediately stop participation of services and disclose said effects to COACH/FACILITATOR/INSTRUCTOR and your medical service provider.
⸻
Confidentiality Statement
YOU understand that some of the YOUR personal and confidential information may be disclosed to COACH/FACILITATOR/INSTRUCTOR, as COACH/FACILITATOR/INSTRUCTOR administers the Services. Likewise, if YOU engage in a group setting for the Services, YOU understand that some of YOUR personal information may be disclosed to other client/participants. COACH/FACILITATOR/INSTRUCTOR agrees to keep all other personal information strictly confidential to preserve the experience for YOU and the group. COACH/FACILITATOR/INSTRUCTOR hereby agrees to keep all of YOUR personal information confidential and for internal purposes only. However, COACH/FACILITATOR/INSTRUCTOR may use some general statements about YOUR participation/progress as testimonials and information on COACH/FACILITATOR/INSTRUCTOR website and/or marketing materials. YOU may choose to remain anonymous in said testimonials upon prior written consent to COACH/FACILITATOR/INSTRUCTOR.
⸻
Emergency Contact
It is possible that certain side-effects, including but not limited to, dizziness and decreased heart rate, may arise when manipulating the breath. In the likelihood that these symptoms or any other symptoms persist to the point of an emergency or YOUR unconsciousness, COACH/FACILITATOR/INSTRUCTOR collects emergency contact information for all clients. You hereby authorize COACH/FACILITATOR/INSTRUCTOR to contact the below representative on your behalf in the event of an emergency during the Services:
⸻
Breathwork Risks
YOU understand that breathwork may involve conscious, rhythmic, or deep breathing and may result in physical, emotional, or psychological responses, including but not limited to:
• Dizziness or lightheadedness
• Tingling, Tetany, or numbness in extremities
• Emotional release or catharsis
• Changes in blood pressure or heart rate
• Temporary feelings of anxiety or discomfort
YOU understand these responses are generally temporary but acknowledge individual experiences may vary.
⸻
⚠️ BREATHWORK CONTRAINDICATIONS & MEDICAL ACKNOWLEDGMENT
YOU confirm that YOU DO NOT have any of the following conditions, OR that YOU have received medical clearance to participate:
• Pregnancy
• Cardiovascular disease, heart conditions, or uncontrolled high blood pressure
• History of stroke, aneurysm, traumatic brain injury or blood clots
• Epilepsy, seizure disorders, or recent head injury or concussion
• Uncontrolled thyroid conditions and diabetes
• Severe asthma or respiratory conditions (mild/moderate ok with an enhaler
• Glaucoma, detached retina, or recent eye surgery
• Severe osteoporosis
• Recent surgery or serious physical injury
• Bipolar disorder, schizophrenia, psychosis, or unmanaged psychiatric conditions
• Severe PTSD or history of dissociation without professional support
• Any other medical, psychiatric or physical conditions which would impair or affect the ability to engage in any activities that involve intense physical and/or emotional release, including any alcohol and/or recreational drug use within the last 48 hours.
⸻
⚠️YOGA NIDRA & SOUND BATH MEDITATION CONTRAINDICATIONS & MEDICAL ACKNOWLEDGMENT
YOU confirm that YOU DO NOT have any of the following conditions, OR that YOU have received medical clearance to participate:
• Pregnancy (generally safe, but participants should inform COACH/FACILITATOR/INSTRUCTOR so positioning and techniques can be adjusted)
• Epilepsy, seizure disorders, or recent head injury or concussion
• Recent surgery or serious physical injury
• Bipolar disorder, schizophrenia, psychosis, or unmanaged psychiatric conditions
• Recent trauma or severe PTSD or history of dissociation without professional support
• Any other medical, psychiatric or physical conditions which would impair or affect the ability to engage in any activities that involve intense physical and/or emotional release, including any alcohol and/or recreational drug use within the last 48 hours.
⸻
⚠️YOGA CONTRAINDICATIONS & MEDICAL ACKNOWLEDGMENT
YOU confirm that YOU DO NOT have any of the following conditions, OR that YOU have received medical clearance to participate:
• Pregnancy, Recent childbirth, or Pelvic floor dysfunction (generally safe, but participants should inform COACH/FACILITATOR/INSTRUCTOR so positioning and techniques can be adjusted
• Musculoskeletal & Physical Conditions, or Hernias
• Cardiovascular & Respiratory Conditions
• Epilepsy, seizure disorders, or recent head injury or concussion
• Neurological Conditions
• Recent surgery or serious physical injury
• Glaucoma, detached retina, or recent eye surgery
• Bipolar disorder, schizophrenia, psychosis, or unmanaged psychiatric conditions
• Recent trauma or severe PTSD or history of dissociation without professional support
• Any other medical, psychiatric or physical conditions which would impair or affect the ability to engage in any activities that involve intense physical and/or emotional release, including any alcohol and/or recreational drug use within the last 48 hours.
⸻
Should YOU have any questions, please consult with a doctor prior to participating in the breathwork journey.
It YOUR responsibility to look after YOUR own health and wellbeing. COACH/FACILITATOR/INSTRUCTOR reserves the right to ask YOU to stop the breath cycle anytime during the Breathwork practice if it should appear that your safety or the safety of the group may be at risk.
⸻
YOU affirm that YOU have disclosed any relevant medical or mental health conditions to the COACH/FACILITATOR/INSTRUCTOR and understand it is YOUR responsibility to consult with a qualified healthcare provider if YOU are unsure whether participation is appropriate for YOU.