LIABILITY WAIVER & CONSENT FORM
The Somatic Shift LLC
Effective Date: 1-17-2025
By signing this document, you acknowledge and agree to the following:
1. Voluntary Participation and Assumption of Risk
I understand that participation in the services provided by The Somatic Shift, including but not limited to group classes, personal training, recovery services (e.g., sauna and cold plunge), somatic breathwork, meditation, nutrition guidance, and coaching, involves inherent risks. These risks may include physical injury, illness (including exposure to communicable diseases like COVID-19), permanent disability, or death. I willingly assume all risks associated with my participation and acknowledge that my involvement is voluntary.
2. Release of Liability
In consideration of my participation, I hereby release and hold harmless The Somatic Shift LLC, its owners, employees, and affiliates, from any and all claims, liabilities, or damages arising from my participation in activities, including those resulting from negligence. This release extends to all services and activities, whether conducted on-site or off-site.
3. Medical Responsibility
I understand that The Somatic Shift does not provide medical advice or treatment. I am solely responsible for consulting with a physician before participating in activities or programs if I have any medical concerns. I confirm that I am medically and physically able to participate and will monitor my own condition during activities.
4. Photography and Video Release
I consent to the use of any photographs or videos taken of me during activities for promotional, marketing, or educational purposes by The Somatic Shift. I waive any right to compensation or ownership of such materials.
5. Breathwork Contraindications
Safety is of utmost importance for Somatic Breathwork. Due to the nature of this work, the deep processes and breathwork there are certain contraindications that may stop you from being able to attend. These are:
Pregnancy
High blood pressure
Diagnosed Severe PTSD
Severe mental health conditions (bipolar, schizophrenia, psychosis)
Currently taking heavy medication that alters brain chemistry (anti-depressant, anti-anxiety, antipsychotic)
Detached Retina
Recent physical injuries, fractures and/or surgeries
Epilepsy
History or diagnosis of aneurysms
Cardiovascular problems
History of seizures
Severe Asthma
Heart disease
Heart conditions
Diabetes
Hospitalization for any psychiatric condition, emotional crisis, or spiritual emergence within the past 3 years
Any other medical, psychiatric or physical conditions that would impair or affect your ability to engage in activities involving intense physical and/or emotional release.
Adverse reactions from recent C-vaccine
Pregnant women are advised against performing somatic breathwork
Participation in a breathwork session is an agreement of the following:
“I acknowledge that breath-work is a deep and powerful process. I have notified the practitioners of any physical injuries, mental or psychological conditions I have. I have read the list of contra-indications listed on the website and they are either not applicable, or I have received permission from my doctor to participate. I engage in this experience willingly and take full responsibility for my own physical, mental and emotional experiences during and after the session.”
6. Mobile Messaging Consent
By providing my mobile phone number, I consent to receive text messages related to services, scheduling, or updates from The Somatic Shift. Standard messaging and data rates apply. I understand that I may opt out of receiving these messages at any time by texting STOP to the appropriate number.
7. Indemnification
I agree to indemnify and hold harmless The Somatic Shift LLC, its owners, employees, and affiliates from any claims, damages, or expenses arising from my actions, omissions, or negligence while participating in activities.
I confirm that I have read and understand this agreement, including the risks involved and the waiver of my rights. I am signing voluntarily and acknowledge that this document is legally binding.