Breathe · Breathwork Sessions

Event Waiver & Release

Name: Stop Budgeting, Start Living: Transform Your Money Mindset, Transform Your Life
Author: Lisa Chastain

Please complete this waiver before participating in a Breathe breathwork session. It takes a few minutes.

Liability Waiver Health Certification Photo & Video Release Touch Consent

Begin Waiver What's Included

Before You Begin

What This Waiver Covers

A quick overview so you know exactly what you're agreeing to.

Participant Details

Your contact information and an emergency contact.

Health Certification

Confirm you are fit to participate. No medical details are collected.

Acknowledgements

Confirm you understand the risks and will participate responsibly.

Touch & Emergency Care

Choose whether you're comfortable with supportive touch, and authorize emergency help if needed.

Release of Liability

Release and hold harmless the event organizers and facilitators.

Guardian Consent

Required only for participants under 18.

Please read carefully. Breathwork involves intentional changes to your breathing that affect your body and emotions. This waiver explains the risks and confirms you are fit to participate. If you have questions before signing, contact Lisa directly.

Breathe Event Liability Waiver

Complete Your Waiver

All fields marked with * are required. We do not ask for or store any medical information.

Breathe is a breathwork program offered by Millennial Consulting LLC, a Nevada limited liability company doing business as Chastain Enterprises (the "Company"). Sessions are facilitated by Giovanni Bartolomeo of Elemental Rhythm Inc. Please read this agreement carefully before signing. It affects your legal rights.

Released Parties

In this agreement, "Released Parties" means: (1) Millennial Consulting LLC, doing business as Chastain Enterprises, and Lisa Chastain, individually; (2) Elemental Rhythm Inc. and Giovanni Bartolomeo, individually; (3) each of their respective owners, members, managers, officers, directors, shareholders, employees, contractors, facilitators, assistants, volunteers, agents, successors, and assigns; and (4) the owner and operator of any venue where a Breathe session is held.

1

Participant Information

Full Legal Name *

Date of Birth *

Email Address *

Phone Number *

Address

Session / Event Date *

Emergency Contact

Contact Name *

Relationship *

Contact Phone *

2

Health Certification

You do not need to tell us about your health. Please read the list below. Breathwork is not recommended for people with any of these conditions unless a physician has cleared them to participate:

Cardiovascular disease, angina, prior heart attack, or high blood pressure
Personal or family history of aneurysm, or a history of stroke or fainting
Epilepsy or a seizure disorder
Glaucoma, retinal detachment, or recent eye surgery
Vertigo or an inner-ear condition
Bipolar disorder, psychosis, or another serious psychiatric condition
Panic disorder, post-traumatic stress, or episodes of dissociation
Pregnancy or breastfeeding
Osteoporosis, or recent surgery or significant injury
Known mineral imbalances (magnesium, potassium, or calcium), or use of diuretics
Asthma or another respiratory condition
Use of alcohol or recreational drugs within the past 24 hours

I certify that I am in good health and fit to participate. None of the conditions listed above apply to me, or my physician has cleared me to participate in breathwork. If I use an inhaler, I will bring it to the session. *

3

Acknowledgements

Nature of the activity. I understand that breathwork involves voluntary, guided changes to my breathing, which may include rapid, deep, or forceful breathing and breath holds. These changes alter the levels of oxygen and carbon dioxide in my blood. Assumption of risk. I understand that breathwork may cause physical and emotional effects, including but not limited to: dizziness, lightheadedness, or vertigo; loss of consciousness; tingling or numbness; tetany, meaning involuntary cramping, stiffening, or temporary loss of control in the hands, feet, face, or around the mouth, which can be severe; headaches; ringing or pressure in the ears; nausea; changes in heart rate or blood pressure; anxiety, panic, or crying; dissociation or feeling disconnected; and the resurfacing of painful memories or emotions. I understand that some effects may continue after the session, typically for up to 24 to 48 hours. I understand these risks and voluntarily assume them, including risks not listed here. Health responsibility. I am solely responsible for deciding whether I am physically and mentally fit to participate. I understand the Company does not collect or review my medical information and relies on my certification above. If my health changes before the session, I will not participate unless my physician has cleared me. Not medical or mental health care. I understand that Breathe is an educational and experiential wellness activity. It is not medical treatment, psychotherapy, or a substitute for either. The facilitators are not licensed medical or mental health professionals. No specific outcome has been promised to me. Safety conditions. I will participate lying down or seated as directed. I will never practice these breathing techniques while driving, in or near water, or anywhere that losing consciousness could injure me or others. If I practice at home, I am solely responsible for my own supervision and safety. Right to stop. I may slow down, modify, or stop at any time. I will tell the facilitator if I feel unwell or uncomfortable. The facilitators may modify or end my participation at any time if they believe it is in my interest or the group's. After the session. I will not drive or operate machinery until I feel fully alert and grounded. If physical or emotional symptoms persist or concern me after the session, I will seek appropriate medical or professional care.

4

Emergency Care

I authorize the facilitators to call emergency services and to arrange or provide first aid if they believe I need it. I accept responsibility for the cost of any emergency transport or medical treatment I receive. *

5

Release of Liability and Indemnity

Release. In exchange for being allowed to participate, I, for myself and my heirs, executors, and assigns, release, waive, and forever discharge the Released Parties from any and all claims, demands, damages, losses, and causes of action of any kind, including those for personal injury, illness, emotional distress, death, and property loss or damage, arising out of or related to my participation in Breathe. This release includes claims arising from the ordinary negligence of the Released Parties. It does not apply to gross negligence or intentional misconduct. * Covenant not to sue. I agree not to bring any claim or lawsuit against the Released Parties that this agreement releases. * Indemnity. I agree to indemnify, defend, and hold harmless the Released Parties from any claims, liabilities, costs, and attorney's fees arising from my participation, my breach of this agreement, or any inaccurate health information I provided, including claims brought by others on my behalf. *

General terms

Governing law and venue. This agreement is governed by the laws of the State of Nevada. Any dispute will be brought only in the state or federal courts located in Clark County, Nevada.
Severability. This release is intended to be as broad as Nevada law allows. If any part is found unenforceable, the rest remains in full effect.
Entire agreement. This is the complete agreement between me and the Released Parties about my participation. No oral statement or promise changes it.
Scope. This agreement applies to the Breathe session on the date listed above and to any activities that are part of that event.
Electronic signature. My typed name and submission are my legal signature. A timestamped copy will be emailed to me.

6

Photo & Video Release

Please choose how you'd like your image to be used. *

I consent to be photographed and recorded.

I grant the Company and Giovanni Bartolomeo permission to use photos, video, and audio of me for promotional, marketing, educational, and social media purposes, without compensation.

I do not consent to be photographed or recorded.

The facilitators will take reasonable care to exclude me from any images or video.

You can change this choice by telling the facilitator before the session begins.

Signature

I HAVE READ THIS AGREEMENT AND UNDERSTAND IT. I UNDERSTAND THAT BY SIGNING IT I AM GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE RELEASED PARTIES FOR NEGLIGENCE. I SIGN IT VOLUNTARILY.

I confirm that all information I provided is accurate and complete. *

Typed Full Legal Name (electronic signature) *

Date *

The Submit button unlocks once every required field and checkbox is complete. Your waiver will be sent securely to the Breathe team, and a confirmation copy will be emailed to you.

Questions

Event Waiver & Release

What This Waiver Covers

Participant Details

Health Certification

Acknowledgements

Touch & Emergency Care

Release of Liability

Guardian Consent

Complete Your Waiver

Released Parties

Participant Information

Emergency Contact

Health Certification

Acknowledgements

Emergency Care

Release of Liability and Indemnity

General terms

Photo & Video Release

I consent to be photographed and recorded.

I do not consent to be photographed or recorded.

Parent or Guardian Consent

Signature

Waiver FAQ