Free Gut Health Breathwork Session
I'm excited for you to try this Theta Breathwork session! Please review & agree to the terms of this waiver to gain access to the session recording.
Waiver for ThetaBreathwork with RAD Nutrition, PLLC
ThetaBreathwork has the ability to physiologically impact and shift your emotional state, so if you fall under any of the following, we strongly advise you to notify your breathwork guide and consult your physician for approval prior to any ThetaBreathwork practice.
Pregnant or nursing
High blood pressure and/or cardiovascular disease
Asthma
Epilepsy
Diagnosed psychiatric disorders
Significant recent physical injuries or surgery
Release of Liability, Waiver, and Assumption of Risk Agreement
In consideration of being permitted to participate in any way in Breathwork with RAD Nutrition, PLLC, I, the undersigned, hereby acknowledge, understand, and expressly agree to the following:
Breathwork can result in intense physical and emotional release. Therefore, it is not advised for persons with a history of cardiovascular disease, including angina or heart attack, high bloodd pressure, use of a pacemaker, glaucoma, retinal detachment, osteoporosis, significant recent physical injuries, or surgery.
Breathwork is not advised for persons with mental illness or seizure disorders or for persons using major medications. It is also unsuitable for anyone with a personal or family history of aneurysms. Pregnant women are advised against practicing Breathwork without first consulting and getting approval from their primary care physician. Persons with asthma should bring their inhaler and consult with their primary care physician and Breathwork class facilitator. This work is deeply experiential. It may involve intense and energetic emotional release.
On behalf of myself, my spouse, my minor children, wards, relatives or other persons under my care, my parents, next of kin, my heirs, assigns, agents, personal representatives, and estate (hereinafter collectively “RELEASING PARTIES”), I HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS RAD Nutrition, PLLC, her employees, agents, representatives, team members, spouse as well as its owners, principals, employees, agents and representatives (hereafter collectively “RAD NUTRITION PLLC RELEASEES”) WITH RESPECT TO ANY AND ALL INJURY, whether physical, mental, psychological or emotional, or ANY LOSS or DAMAGE TO PERSON OR PROPERTY of any kind, WHETHER ARISING FROM THE NEGLIGENCE OF RAD NUTRITION PLLC RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
To the fullest extent allowed by law, I agree to defend, indemnify, and hold harmless RAD NUTRITION PLLC RELEASEES for all costs and expenses, including but not limited to all legal fees incurred by RAD NUTRITION PLLC RELEASEES in defending any claim brought against any or all of RAD NUTRITION PLLC RELEASEES by any of the RELEASING PARTIES and further agree to pay the full amount of any judgment, award or verdict that might be entered against any of RAD NUTRITION PLLC RELEASEES and/or in favor of any or all of the RELEASING PARTIES.
I understand there is a risk of physical, mental, psychological or emotional injury or death from the activities, and although personal discipline or compliance with the guidance of RAD NUTRITION PLLC RELEASEES may reduce this risk, the risk of such injury nevertheless does exist.
I am fully aware that the activities could be hazardous resulting in injury or death. I fully acknowledge that I am voluntarily participating in the activities with knowledge of the danger involved, and I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES of others, and assume full responsibility for my participation.
I agree to comply with the stated and customary guidance and norms of participation in the activities. If, however, I observe any unusual hazard during my presence or participation, I will immediately remove myself from participation in the activities and bring such attention to the nearest official forthwith.
I know, understand, and acknowledge that RAD NUTRITION PLLC RELEASEES are NOT physicians, psychologists, therapists, or healthcare professionals, and the activities being offered are NOT intended to treat or diagnose, and does NOT include treatment for or diagnosis of, any illnesses, diseases, or disorders whether physical, mental, psychological or emotional.
I promise, represent, and certify that I am in good health physically, mentally, psychologically, and emotionally, and fully understand and acknowledge that if I were not in such good health, I would not be permitted to partake in the activities. As such, my promise, representation, and certification that I am in good health in each of the above-enumerated ways constitute a material term upon which RAD NUTRITION PLLC RELEASEES are relying in permitting me to partake in the activities.
If I am pregnant or become pregnant or am post-natal, I will not participate in the activities without first discussing the risks with my physician, and I will only participate in the activities if I have my physician's full approval. I will not hold the RELEASED PARTIES responsible for any injuries to my pregnancy caused in part or in whole by my failure to follow my doctor’s recommendation.
To the fullest extent allowed by law I, on behalf of myself and all RELEASING PARTIES, hereby forever unconditionally and irrevocably waive and release any and all claims I now have or may in the future have against RAD NUTRITION PLLC RELEASEES with respect to any injury, loss or damage I suffer as a result of participating in the activities of any of the future activities in which I may participate. I understand and agree that this Release of Liability, Waiver, and Assumption of Risk Agreement (hereinafter “Agreement”) extends to and includes any and all damages, injuries, and claims which I do not anticipate or know to exist and to any and all damages, injuries or claims which may develop in the future, and I hereby expressly waive and relinquish any and all rights under any law of statue to the contrary.
After being fully informed of the above, I, on my own behalf, and, to the fullest extent allowed by law on behalf of all RELEASING PARTIES expressly agree and promise to accept and assume all of the risks inherent to and existing in connection with the activities; and I voluntarily elect to participate in the activities.
Although this Agreement and completely releases RAD NUTRITION PLLC RELEASEES from any and all liability of any kind of any nature in any way connected to, arising from, or relating to the Activities at issue, I further acknowledge and agree that to the extent I violate the plain terms of this Agreement by filing a claim, suit or other action against any of the RAD NUTRITION PLLC RELEASEES, any such claim, suit or other action shall be filed solely and exclusively before the American Arbitration Association, as governed by the Commercial Rules of Arbitration, with the initiating party bearing the fees and costs associated with arbitration, and with the prevailing party entitled to recover reasonable attorneys’ fees and costs associated with the arbitration. Any legal or equitable claim that may arise from participation in the above shall be resolved under Illinois law.
I acknowledge, understand and agree that this Agreement, and all of the releases, terms and conditions contained herein, shall apply with equal force and govern any future Activities in which I partake with Rachel Doyle or any of the other RAD NUTRITION PLLC RELEASEES, thus obviating the need for me to sign this Agreement each and every time I partake in the activities.
I understand and agree that RAD NUTRITION PLLC RELEASEES are not responsible for property that is lost, stolen, or damaged while in, on, or about the premises.
To the extent that any portion, clause or aspect of this agreement is found to be invalid, void or unenforceable, all other portions, clauses, or aspects of this agreement shall remain in full force and effect.
I have read this release of liability and assumption of risk agreement, fully understand its terms and I have either consulted an attorney or, at my sole discretion, elected not to do so.
I understand that I am providing this release as consideration, in part, for participation in the activities. As such, I understand that if I wish to alter or negotiate the terms of this Agreement, I may do so by speaking with one of RAD NUTRITION PLLC RELEASEES.
I understand that I have given up substantial rights by signing this release of liability and assumption of risk agreement and sign it freely and voluntarily without any inducement.
PROTECTION OF CONFIDENTIAL INFORMATION. The Recipient understands and acknowledges that the Confidential Information has been developed or obtained by the Owner by the investment of significant time, effort and expense, and that the Confidential Information is a valuable, special and unique asset of the Owner which provides the Owner with a significant competitive advantage, and needs to be protected from improper disclosure. In consideration for the receipt by the Recipient of the Confidential Information, the Recipient agrees as follows:
No Copying/Modifying. The Recipient will not copy or modify any Confidential Information without the prior written consent of the Owner.
Unauthorized Use. The Recipient shall promptly advise the Owner if the Recipient becomes aware of any possible unauthorized disclosure or use of the Confidential Information.
UNAUTHORIZED DISCLOSURE OF INFORMATION - INJUNCTION. If it appears that the Recipient has disclosed (or has threatened to disclose) Confidential Information in violation of this Agreement, the Owner shall be entitled to an injunction to restrain the Recipient from disclosing the Confidential Information in whole or in part. The Owner shall not be prohibited by this provision from pursuing other remedies, including a claim for losses and damages.
LIMITED LICENSE TO USE. The Recipient shall not acquire any intellectual property rights under this Agreement except the limited right to use as set forth above. The Recipient acknowledges that, as between the Owner and the Recipient, the Confidential Information and all related copyrights and other intellectual property rights, are (and at all times will be) the property of the Owner, even if suggestions, comments, and/or ideas made by the Recipient are incorporated into the Confidential Information or related materials during the period of this Agreement.
By signing this document, I acknowledge that if anyone is injured or killed, or if property is damaged, during my participation in the activities, I will be found by a court of law to have waived all right to maintain suit against any of RAD NUTRITION PLLC RELEASEES and/or that I will be found to be fully responsible for all attorney fees and all other costs incurred by RAD NUTRITION PLLC RELEASEES and/or that I will be found personally liable for any judgment, award or verdict entered against any of RAD NUTRITION PLLC RELEASEES.
I understand that there exists known and unknown dangers of serious injury and death associated with the activities, some of which are referenced above, nevertheless choose to participate in the activities.
Photographs, Publicity Material, Radio and Television and Print Media:
I do hereby irrevocably grant to RAD NUTRITION PLLC RELEASEES the absolute right and permission to record my likeness and/or voice with still photography, film, videotape or digital media, to edit such still photographs, film, videotape or digital media at the discretion of RAD NUTRITION PLLC, to incorporate the same into photo exhibits, motion picture films, video or digital media and Internet presentations, to use or authorize the use of still photographs, films, videotapes, digital media, or any portion thereof, in any manner at any time or times throughout the world in perpetuity, to copyright, use, reuse, publish, republish, exhibit, display, print and reprint in advertising, publicity or promotional material, magazines, books or any other digital media including the Internet, to use or authorize the use of soundtrack records and records of me or my voice, including the right to use my name, likeness, and biographical and other information concerning me in connection with the exhibition, advertising, promotion or any other use of such still photographs, films, and/or videotapes or other digital media without compensation to me.
Thereby waive any right to inspect or approve the still photographs, films, videotapes or digital media or the editorial or printed matter that may be used in conjunction therewith and further waive any claim that I may have with respect to the eventual use to which they may be applied. Such still photographs, films, videotapes, or digital media may be used at RAD NUTRITION PLLC’s sole discretion, with or without my name.
Thereby release, discharge and agree to save harmless RAD NUTRITION PLLC RELEASEES from any and all claims, damages, liabilities, costs, and expenses that I now have or may hereafter have by reason of any use of the film, videotapes, photographs or other digital media thereof.
BY WRITING YOUR NAME AND THE DATE BELOW AND SUBMITTING THIS FORM, YOU ARE INDICATING THAT YOU UNDERSTAND THE INFORMATION CONTAINED ABOVE AND AGREE WITH IT.
I hereby confirm that I read the information above, and I indicate that I understand the information contained above and agree with it.