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MIDWEEK NERVOUS SYSTEM RESET CALM

LIABILITY WAIVER FORM

At Love & Sound Therapies, we prioritise the safety, wellbeing, and comfort of all participants. Completion of this Midweek Nervous System Reset Calm Liability Waiver Form is required prior to participation.

Date of Signature

This waiver will be valid for 12 months.

First Name

Last Name

Phone *

Email *

Please confirm if you are currently pregnant.

Yes

(N/A) Not Applicable

Please list any health or medical conditions you have. Kindly type "NONE" if none.

Medical Contraindications & Health Status

Midweek Nervous System Reset Calm sessions may not be suitable for individuals with the following conditions:

Cardiovascular disease
Abnormally high blood pressure
Aneurysms
Epilepsy or history of seizures
Severe psychiatric conditions (including psychosis or paranoia)
Bipolar disorder
Osteoporosis
Recent surgery or serious injury
Glaucoma
Pregnancy
Anyone taking heavy medication that affects the nervous system

People with asthma must bring their own inhaler and are advised to consult their medical practitioner prior to participation.

Anyone currently experiencing an emotional or psychological crisis, or any mental illness that is unmanaged or lacks adequate professional support, is advised not to participate at this time.

This list is not exhaustive. If you have any medical, emotional, or mental health condition not listed above, you are advised to consult a medical professional before participating and to speak with the facilitator prior to the session.

Somatic Touch & Guided Movement

I acknowledge that this session may involve optional somatic touch and/or guided movement, including mindful contact such as gentle pressure or physical guidance to support energetic release or grounding.

I understand that:

Consent will be checked during the session
My boundaries will be fully respected at all times
Touch is never mandatory
I may withdraw consent at any time by verbal communication or hand signal

Warranty of Health

I warrant and represent that I am physically, mentally, emotionally, and psychologically fit to participate in breathwork sessions. I understand that if I am not in suitable health, I may be advised not to participate or to modify my involvement.

My declaration of health constitutes a material agreement to participate in these sessions.

Scope of Practice

I acknowledge that the facilitator is not a medical doctor, psychologist, psychiatrist, or licensed healthcare provider. Breathwork sessions are not intended to diagnose, treat, cure, or prevent any medical or psychological condition.

These sessions are provided as complementary wellness practices and are not a replacement for medical, psychological, or psychiatric care.

Assumption of Risk & Release of Liability

I voluntarily choose to participate in breathwork sessions at Love & Sound Therapies, fully understanding the nature of the activity and the potential risks involved.

I agree to assume full responsibility for all risks, known or unknown, and hereby release Love & Sound Therapies, its facilitators, assistants, and affiliates from any liability, claims, costs, or damages arising from participation.

I agree to accept financial responsibility for any medical or therapeutic treatment required as a result of participation.

Media & Recording Consent

I understand that photos, audio, or video recordings may be captured during sessions for promotional, educational, or informational purposes.

I grant permission for my image, voice, or likeness to be used respectfully by Love & Sound Therapies. If I do not wish to appear in any media, I understand it is my responsibility to notify the facilitator prior to the session commencing.

Acknowledgement of Understanding

I confirm that I have read, understood, and voluntarily agree to the terms of this waiver. I acknowledge that participation is voluntary and that I may withdraw from the session at any time.

Governing Law

This agreement is governed by the laws of Queensland, Australia.

By checking this box, I acknowledge and agree to the following:Medical Safety & Warranty: I have reviewed the full list of medical contraindications for Midweek Nervous System Reset Sessions. I warrant that I am in suitable physical and mental health to participate and will bring a personal inhaler if I am asthmatic.Personal Responsibility: I accept full responsibility for my physical and emotional well-being and understand I am responsible for listening to my body during the journey.Liability Release: I voluntarily assume all risks and release Love & Sound Therapies, its facilitators, and affiliates from any claims, costs, or damages arising from my participation.Somatic Touch & Media: I understand that any somatic touch is optional and consent-based. I also grant permission for my likeness to be used in media unless I notify the facilitator otherwise before the session.Scope of Practice: I acknowledge that this is a wellness practice and not a replacement for professional medical or psychiatric treatment.Governing Law: I agree that this waiver is governed by the laws of Queensland, Australia.I confirm that I have read, understood, and voluntarily agree to all the Terms and Conditions listed above. *

Yes

EmergencyContactFirstname

EmergencyContactPhone

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