Breathwork Journey with Amy

Tickets are non-refundable due to limited capacity.

THIS RELEASE IS A BINDING LEGAL CONTRACT, PLEASE READ IT CAREFULLY BEFORE SIGNING. I understand that in the case of a medical emergency, I authorize the calling of an emergency contact and/or doctor and the providing of necessary medical services in the event tha I am injured or becomes ill. I understand that Wellstock, Inc will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility. 2. In case of an emergency, and if a family physician cannot be reached, I give permission to be treated by a Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician). 3. I understand that participation includes possible exposure to and illness from infectious diseases including by way of illustration but not as limitation to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, 4. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation; and, 5. I willingly agree to comply with the stated and customary terms and conditions for participation regarding protection against infectious diseases. If, however, any unusual or significant hazards are observed during my presence or participation, I will remove myself from participation and bring such to the attention of Wellstock immediately; and, 6. I hereby release and hold harmless Wellstock Inc. their officers, officials, agents, and/or employees, other participants, and if applicable, owners and lessors of premises used to conduct the Program (“Releasees”), with respect to any and all illness, disability, death, or loss or damage to person or property, whether arising from the negligence of releasees or otherwise, to the fullest extent permitted by law. By signing below, I acknowledge that I have carefully read this voluntary Waiver and understand the potential dangers incident to engaging in the Program and are fully aware of the legal consequences of this agreement.

THIS RELEASE IS A BINDING LEGAL CONTRACT, PLEASE READ IT CAREFULLY BEFORE SIGNING. Breathwork Waiver: Breathwork has the following contraindications. It's crucial that you inform the facilitator if you have any of the below. Should you have any questions, please consult with a doctor prior to participating in the journey. - pregnancy - severe asthma (mild and moderate OK with an inhaler) - detached retina - glaucoma - high blood pressure not controlled by medication - cardiovascular disease - diagnosis of an aneurysm in the brain or stomach - uncontrolled thyroid conditions and diabetes - epilepsy - prior diagnosis of bipolar disorder, schizophrenia, or previous psychiatric condition - hospitalization of psychiatric illness in the last 10 years - Any other medical, psychiatric or physical conditions which would impair or affect the ability to engage in any activities that involve intense physical and/or emotional release. It is each person's responsibility to look after their own health and wellbeing. I will support you in offering you an alternative or altered breathwork journey to support you. By signing this informed consent disclosure, you acknowledge that you understand what you are reading and agree to the following: I agree to engage Amy Shearer (Coach) and Wellstock to provide certain services, which may include the following holistic practices and techniques: · Breathwork Techniques, which Merriam-Webster defines as “conscious, controlled breathing done especially for relaxation, meditation, or therapeutic purposes”; Although COACH is trained to perform the above Breathwork Services, COACH is not a licensed therapist, medical professional or other mental health care provider; in order to get medical advice, Client must see a doctor. COACH does not represent the Services as any form of health care or psychotherapy, and despite research to the contrary, by law COACH may make no health benefit claims for said Services. However, these holistic practices are client-centered disciplines, in which COACH is highly trained to assist Client to accomplish their goals, whatever they may be, using the Services described above. Nevertheless, the Services may not be regulated by any government or administrative body. COACH also does not provide any type of therapy services, despite the word “therapeutic” being included in the common definition of breathwork; the type of Services utilized by COACH are non-therapeutic in nature and are designed to supplement treatment and/or advice from licensed medical and mental health providers. Nothing in the Services shall be construed as a substitute for the treatment or advice of a doctor or other licensed medical professional. Breathwork Disclaimer: COACH and Wellstock does not represent the Services as any form of health care or psychotherapy, and despite research to the contrary, by law COACH may make no health benefit claims for said Services. Client hereby acknowledges that breathwork is not a substitute for medical care, as breathwork neither diagnoses nor treats any medical conditions. Instead, breathwork provides tools for you to complement your medical or other treatments. If any medical symptoms persist or progress, even acutely, you hereby agree to inform your medical provider immediately and seek medical attention. You also hereby agree to notify COACH with any updates to your medical condition after beginning Services and to indemnify COACH of any health issues that may persist or progress whilst working with COACH. Results Disclaimer: Client also acknowledges that COACH and Wellstockcannot and does not guarantee that implementation of the Coaching Services and Program will provide Client with an ideal resolution and/or perfect life. Throughout the Services, COACH may help Client think through and analyze decisions and assist Client with finding his/her own direction. The COACH may offer her opinion regarding decisions, but it is the responsibility of Client to make the final decision and choose the best option for his/herself. Client also agrees that he/she is solely responsible for any personal and/or professional decisions and indemnifies COACH and Wellstock from any liability regarding said decision. If, at any point during the Services, you feel any adverse effects from any of the Services and/or techniques defined above, you hereby agree to immediately disclose said effects to COACH and your medical service provider. Confidentiality Statement: Client understands that some of Client’s personal and confidential information may be disclosed to COACH, as COACH administers the Services. Likewise, if Client engages in a group setting for the Services, Client understands that some of Client’s personal information may be disclosed to other clients. Client agrees to keep all other clients’ personal information strictly confidential to preserve the experience for the group. COACH hereby agrees to keep all of Client’s personal information confidential and for internal purposes only. However, COACH may use some general statements about Client’s progress as testimonials and on COACH’s website and/or marketing materials. Client may choose to remain anonymous in said testimonials upon prior written consent to COACH. Emergency Contact: It is possible that certain side-effects, including but not limited to, dizziness and decreased heart rate, may arise when manipulating the breath. In the likelihood that these symptoms or any others persist to the point of an emergency or Client unconsciousness, COACH collects emergency contact information for all clients. You hereby authorize COACH and Wellstock to contact the emergency contact listed on your behalf in the event of an emergency during the Services: