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listen to stories of shared resilience on the SHHL Podcast. learn how breath-work can improve your day to day life.

Breath Work Consent & liability Application Waiver Form.

Breathwork Consent & Liability Application Waiver Form

Welcome to Strong Happy Healthy Loved Pty Ltd (SHHL).

Before participating in any breathwork session — online, in-person, or in a group — please complete this form.

Your safety and well-being are our priority.

Full name*

Phone*

Email*

Birthday*

Day

Month

Year

What program are you interested in?

1 on 1 introduction to breathwork with Carl

4-Phase Breakthrough System

Breathwork introduction Group

✅ SAFE PARTICIPATION CHECK

I am currently in a safe and stable living environment.

I am not experiencing suicidal thoughts or recent self-harm urges.

I have not been hospitalised for mental health reasons in the past 6 months.

I understand that strong emotions may arise during breathwork.

I take full responsibility for my emotional and physical wellbeing.

I will seek professional medical or psychological support if needed.

I agree to inform SHHL if any of the above statements are not true.

“Do you have or have you ever experienced any of the following conditions?”

Cardiovascular problems

High or low blood pressure

Aneurysms

Epilepsy or seizures

Severe psychiatric symptoms (psychosis, bipolar, paranoia)

Osteoporosis

Pregnancy or possible pregnancy

Asthma (bring inhaler if applicable)

Taking heavy medication

Experiencing emotional or spiritual crisis

None of the above

If you selected any of the above, please consult your doctor before participating.

Participant Declaration

I declare that I am in good physical, mental, and emotional health, and I understand that SHHL facilitators are not doctors or therapists.

I acknowledge that breathwork sessions are intended for personal growth and relaxation, not for diagnosis or medical treatment.

I take full responsibility for my physical and emotional well-being during and after each session.

Liability Release

I voluntarily participate in SHHL breathwork sessions, fully aware of the potential risks and effects.

I release Strong Happy Healthy Loved Pty Ltd, its facilitators, and representatives from all liability, claims, or damages that may arise from participation.

I waive any legal rights to pursue claims related to my participation and accept full personal responsibility for my experience.

By ticking this box, I confirm that I have read, understood, and agree to all of the above terms. I voluntarily release Strong Happy Healthy Loved Pty Ltd and its facilitators from all liability.

Media consent

I consent to photos or videos being used by SHHL for promotional or educational purposes.

Agreement Confirmation

I am over the age of 18 years old

By ticking this box, I confirm that I have read, understood, and agree to all of the above terms. I voluntarily release Strong Happy Healthy Loved Pty Ltd and its facilitators from all liability.

What feels most important for you to work on right now?

Date picker*

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