As additional consideration for receiving BREATHWORK and other services from Shelly Belk Coaching LLC (the “Company”), I voluntarily enter into this Agreement and Waiver and Release of
Liability (“Agreement”) with the Company. This Agreement shall apply to all services provided by the Company and any other individual authorized by the Company to provide coaching or other instruction to me during my engagement.
1. Confidentiality. I agree to preserve the sanctity and safety of any group coaching process in which I participate by maintaining the confidentiality of all information communicated by other clients during group breathwork sessions. I agree not to disclose any teleconference bridge numbers or other access codes to any third party.
2. BreathWork/Somatic Work. I acknowledge that I have voluntarily enrolled in this Breathwork activity. I understand that I am under no obligation of any kind to participate in this Breathwork/Somatic Work activity and I voluntarily enter into this Waiver and Release of Liability. I understand that Breathwork/Somatic Work is a personal
growth experience designed to enhance the quality of life, and is not a substitute for psychotherapy. I understand that this Breathwork/Somatic Work activity will involve strong connected breathing and may include guided meditation. I understand that Breathwork/Somatic Work can involve dramatic experiences accompanied by strong emotional and
physical responses. I understand that I may find Breathwork/Somatic Work physically, emotionally, and/or mentally stressful.
3. Refunds. I acknowledge that no refunds will be given if I am unable to make the scheduled class. A recording will be made available to me for 7 days following the scheduled class.
I hereby affirm that I am in good health and able to participate in this activity. I do not have any physical or mental conditions which would impair my ability to engage in this activity or which would otherwise endanger my health during this Breathwork/Somatic Work activity, or which would cause any risk of harm to myself or other participants. I understand that this Breathwork/Somatic Work activity is not medically supervised.
I have hereby been advised that I should talk to my physician and/or psychotherapist if I have any questions about my physical or mental ability to safely participate in this Breathwork/Somatic Work activity. If I have chosen not to obtain a physician's consent prior to my participation in Breathwork/Somatic Work, I hereby agree that I am doing so solely at my own risk. I understand that it is my sole responsibility to participate in activities that are appropriate for the current status of my health and to modify this Breathwork/Somatic Work activity to accommodate my own needs or limitations. If I have any questions or concerns about whether or not a particular activity is appropriate to my current health status, I understand it is my responsibility to ask my doctor before I participate in such activity. I agree to indemnify and hold harmless Rochelle Belk, Shelly Belk Coaching LLC. from and against any and all claims and expenses, including attorney’s fees, arising out of my participation in this Breathwork/Somatic Work activity. In consideration of my participation in this Breathwork/Somatic Work activity, I hereby waive and release Rochelle Belk, Shelly Belk Coaching LLC from any and all claims, costs, liability and expense for any injury, loss or damage whether known, anticipated or unanticipated arising from my participation in Breathwork/Somatic Work.
This Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I acknowledge that I have thoroughly read this Waiver and Release of Liability in its entirety and fully understand it. By signing this document, I am waiving certain rights I and/or my successors might have to bring legal action or assert a claim against Rochelle Belk or Shelly Belk Coaching LLC.
I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE
THAT BY ACCEPTING THIS AGREEMENT, I AM WAIVING AND RELEASING IMPORTANT LEGAL RIGHTS.
