Welcome: Please read the following. Let me know if you have any contraindications, and check the box at the bottom only if you accept :) 

Name of Facilitator (Releasee): Cari Bourquin 

I the releasor understand and acknowledge that the discussions, consultations, and breathwork session(s) I have with the release Cari Bourquin are not intended to replace any relationship I have with my primary health care provider(s); and are not intended to constitute medical advice. 

I acknowledge that I am responsible for consulting a medical doctor before joining a breathwork in the event that I am on medications, or that I have or am suspected to have any sort of health condition. 

Contraindications (please read thoroughly): I understand that if I am taking any medications or have any medical conditions I must advise the facilitator/s and consult with a medical doctor prior to breathing. I understand that this breath style is contraindicated for conditions such as, but not limited to: 

1. Epilepsy or history of seizures 

2. Schizophrenia, bipolar disorder, psychosis 

3. Cardiovascular disease, heart conditions, diagnosed brain or abdominal aneurysm, stroke, or heart attack 

4. Recent surgery or unhealed major physical injury 

5. Glaucoma, detached retina 

6. Asthma (unless you have your inhaler with you) 

7. Early stage or complicated pregnancy 

8. Uncontrolled diabetes, thyroid conditions, or high blood pressure 9. Panic attacks 

While Breathwork may be feasible with certain outlined above conditions, obtaining

approval from both your medical provider and Breathwork Facilitator is essential before participation. 

I understand that loud music is used to support altered states in these sessions. If I have a sensitivity to noise, it is my responsibility to bring earplugs to any group sessions and to let the facilitator know in advance. 

I certify that I have come to this Breathwork sober, and have not used any antipsychotic medications, plant medicines, or any other type of drug in the past 48 hours. I understand breath holding can be unsafe during conscious connected breathwork and agree to not hold my breath on purpose in this session. 

I understand and acknowledge that, in undertaking a breathwork session with the Release Cari Bourquin, I am doing so at my own risk. It is with that understanding that I voluntarily execute this release and waiver. 

I understand that on occasion, promotional photos may be taken. I also understand I can elect to not be in the photo at all by simply telling Cari so. 

I understand my experiences and actions in the breathwork are fully in my control and if things become too overwhelming, I take responsibility to come back to a normal breath to calm down my system. I understand that everything that happens and anything that is 

said before, during and after a breath session will remain completely confidential, so long as no harm is inflicted on the facilitator. I understand that a breathwork session may include physical touch designed to support me in my journey and that I have the right to refuse touch by using the word ‘stop’ at any time. 

I, acting on behalf of myself, hereby release the Release from any liability, any actions, causes of action, complaints, claims, damages, costs, and expenses of any kind with respect to or arising out of any the discussions, consultations and/or breathwork session(s) I have had or may have with the Release. I also release the Releasee and

any establishments where the Breathwork is held from liability now and forever for any and all future Breathworks or consultations I partake in with Cari. 

By filling out and submitting the form, you acknowledge and agree that your electronic checkbox mark constitutes a legally binding agreement, equivalent to your handwritten signature, and that you are voluntarily entering into this waiver and release agreement ("Agreement"). 

If you have any contraindications, questions, or concerns please reach out to me at Cari@Chaparralgardens.com