WINGS OF WELLBEING WAIVER & RELEASE

Wings of Wellbeing refers to the business of Wings of Wellbeing and its primary
practitioner/facilitator and business owner Victoria Gautier. This waiver and release
will extend to any collaborating businesses and those affiliated practitioners
providing services or support within events.

 

Breathwork Informed Consent:
Breathwork refers to any type of breathing exercise or technique in which a person
intentionally changes their breathing pattern. There are many forms of breathwork
therapy that involve breathing in a conscious and systematic way, often performed to
improve mental, physical, and spiritual well-being. Breathing itself can last for
anywhere from 30 to 90 minutes depending on the participants individual journey
and what the facilitator deems appropriate for the session.

The participant is simply asked to remain open to whatever kind of experiences
present themselves during the breathwork session. This can include, but is not
limited to, deeply restful or ecstatic states, vivid reliving of past experiences, release
of energy from the body, tetany of the hands, feet, legs or face, strong tingling
sensations, strong emotions (either pleasant or difficult), spiritual experiences or
experiences from other transpersonal areas of consciousness.

The facilitator’s role during the session is to oversee the breathing cycle and ensure
it is maintained, as well as perform direct and non-direct forms of bodywork.

 

Breathwork is a powerful experiential tool for accessing altered states of
consciousness. As this process can bring up intense emotions and strong physical
sensations in some, it is not recommended for those with certain types of conditions
including: head injuries, heart conditions, severe hypertension, glaucoma, epilepsy,
pregnancy, recent surgery, serious mental health conditions, or other physical
limitations. If you have any doubt about whether you should participate, consult your
physician or therapist, as well as your facilitator before attending.

Breathwork may activate a heightened emotional state which can continue beyond
the time of the breathwork session, for which post session therapy and support is
recommended. Breathwork is intended as a personal growth experience and should
not be looked upon as a substitute for psychotherapy.

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For the safety of the participants, the facilitator reserve the right to discontinue
services based on contraindications including, but not limited to, those listed above.

 

Waiver Statement:
In order to participate in the event I hereby:-
Release Wings of Wellbeing from any liability now or in the future for any injury
caused, occurring during, or after, my participation in a Wings of Wellbeing event or
service.

 

*Agree to assume full responsibility for all injuries or damage which are sustained or
aggravated by me in relation to a Wings of Wellbeing event or service.
Release, and indemnify Wings of Wellbeing, subsidiary affiliates, and each of their
respective representatives from all responsibility, claims, actions, suits, expenses,
damages, and liabilities to the fullest extent allowed by law.

 

*Affirm that I have no medical or physical condition that would prevent me from fully
participating in a Wings of Wellbeing event or service.
Verify that I do not have a physical or mental condition that would put me in any
physical or medical danger.

 

*I acknowledge that if I have any chronic disabilities or conditions, I am at risk by
participating in a Wings of Wellbeing event or service.

 

*I understand that Wings of Wellbeing events and services are intended as personal
growth experiences and should not be used as a substitute for psychotherapy and
that the facilitator/s are not acting as psychotherapists.

 

*I understand that breathwork may involve vivid somatic experiences, accompanied
by strong emotional and physical sensations.

 

*I understand that since my experience will be unique, despite any representations
made by the facilitators, or in any websites or other marketing materials relating to a
Wings of Wellbeing event or service, the facilitator/s cannot guarantee that
participating in the session will lead to any specific type of experience, result, or
benefit.

 

*I acknowledge that consuming alcohol or mind-altering substances prior to this
service is not permitted. Facilitator/s may refuse my participation if they feel I may be
negatively affected by any substances.

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Publicity Release:
I agree that Wings of Wellbeing may photograph and record me and may use these
photographs and recordings for promotional purposes. I give my consent to Wings of
Wellbeing that they may display photographs and recordings of my image online,
through websites and social media platforms to promote Wings of Wellbeing
business and operations. I have the right to refuse my image being shared publicly at
any stage, and agree to notify the facilitator of this decision.

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Payment information
Payment Terms:
Minimum deposit of $100 is payable upon booking.
Cancellations made more than 7 days from the booked session will receive a credit
to arrange an alternative, mutually convenient time.

Cancellations made within 7 days of the session will not receive a credit or a refund.

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Refund Policy:
I understand that if I cancel my booking within 24 hours of the booking, that I will be
required to pay the full amount and will not be entitled to any reimbursement for any
reason.

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I have read Wings of Wellbeing Waiver and Release, fully understand its terms, and
understand that I am giving up my right to take legal action against Wings of
Wellbeing. I acknowledge that I am signing this waiver freely and voluntarily. The
term of this waiver is indefinite.
The submission of this form electronically constitutes a signature.

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Victoria Gautier 
Wings of Wellbeing 
Nairne 
GPO 

South Australia 5252 Australia 

 

Mobile: 0416 461 482 
www.facebook.com/wingsofwellbeing  

 
Member of IICT 
Associate Member of 

International Medical and Dental Hypnotherapy Association