Breathwork Liability Waiver & Informed Consent
(Professional Facilitator Version)
This Liability Waiver and Informed Consent Agreement (“Agreement”) is entered into between Julia
Dietze, doing business as “The Breath of Avalon” (“Facilitator”), and the undersigned participant
(“Client”). By signing this Agreement, the Client confirms they have read, understood, and voluntarily
agreed to all terms before participating in any breathwork session, workshop, coaching program, or
related activity.
1. Nature of Breathwork Practice
Breathwork is a somatic wellness practice that uses conscious breathing techniques designed to
support emotional release, nervous system regulation, relaxation, and personal development.
Participation may produce intense physical, emotional, or psychological responses including but not
limited to tingling sensations, dizziness, muscle contractions, emotional catharsis, or altered states of
awareness.
2. Not Medical or Psychological Treatment
The Facilitator is not a licensed medical doctor, psychologist, psychotherapist, or healthcare provider.
All services are provided for educational and personal development purposes only and are not intended
to diagnose, treat, cure, or prevent any medical or psychological disorder. Clients should consult
qualified medical or mental health professionals regarding medical conditions or psychological
concerns.
3. Emotional Release Acknowledgment
Breathwork may facilitate the release of suppressed emotions, traumatic memories, grief, anger, or
stress. The Client understands that emotional processing may continue after sessions and agrees to
take responsibility for seeking additional professional support if needed.
4. Online Session Disclaimer
If sessions are conducted online, the Client acknowledges that the Facilitator cannot control the
physical environment of the Client. The Client agrees to participate in a safe space where they can lie
down or sit comfortably and stop the practice if necessary.
5. Health Contraindications Breathwork may not be suitable for individuals with certain medical conditions. Contraindications may
include but are not limited to: cardiovascular disease, severe hypertension, epilepsy or seizure
disorders, glaucoma, detached retina, pregnancy without physician approval, recent surgery, severe
psychiatric conditions, or serious respiratory illness. The Client confirms that they have disclosed any
relevant medical information.
6. Assumption of Risk
The Client understands that participation in breathwork practices involves inherent risks including
physical sensations, emotional responses, or psychological reactions. The Client voluntarily assumes
full responsibility for any risks associated with participation.
7. Personal Responsibility
The Client agrees to listen to their body and immediately stop the practice if discomfort arises. The
Client accepts full responsibility for their physical, emotional, and psychological well-being during and
after participation.
8. Release of Liability
To the fullest extent permitted by law, the Client releases and holds harmless the Facilitator, The
Breath of Avalon, and any assistants, contractors, or affiliates from any and all claims, injuries, losses,
damages, or liabilities arising from participation in breathwork sessions, coaching programs, or related
activities.
9. Confidentiality
The Facilitator will respect the confidentiality of Client information. However, confidentiality cannot be
guaranteed in group sessions. Participants agree to respect the privacy of other participants.
10. Integration Responsibility
The Client acknowledges that personal insights or emotional experiences may arise following sessions.
The Client is responsible for integrating these experiences and agrees to seek professional support if
needed.
11. Governing Law
This Agreement shall be governed by the laws of the State of California. Any disputes arising under this
Agreement shall be resolved within the jurisdiction of courts located in San Diego County, California.12. Acknowledgment of Understanding
By signing below, the Client acknowledges that they have carefully read this Agreement, fully
understand its contents, and voluntarily consent to participate in breathwork sessions or programs.
Client Name:
Signature:
Date:
