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The Energy Studio Uluwatu Empress Journey

Participant Medical & Liability Waiver form

We are thrilled to embark on this transformative journey with you. At The Energy Studio, your well-being and safety are our top priorities. To ensure a secure and enriching experience, we ask you to carefully review and sign this Release and Waiver of Liability Form.

 

This document establishes a legally binding agreement between you (the "Participant") and The Energy Studio, the organisation offering breathwork, meditation, Kundalini yoga, Reiki, and other guided instructor-led experiences.

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By signing this form, you acknowledge that you have read, understood, and agreed to the terms and conditions outlined below.


ASSUMPTION OF RISK & INFORMED CONSENT

I understand that participating in breathwork, meditation, Kundalini yoga, Reiki, and other guided experiences involves inherent risks, both known and unknown, including but not limited to:


  • Physical exertion, strenuous activity, and exposure to extreme environmental conditions.

  • Health risks associated with breathwork, including but not limited to hyperventilation, dizziness, fainting, breath-holding, changes in blood pressure, and potential adverse psychological reactions.

  • Hazards related to the activities, such as falls, uneven terrain, wildlife encounters, and unpredictable natural elements.

  • Emotional and energetic shifts resulting from deep internal work, which may surface unresolved emotions or past trauma.


I acknowledge that I am voluntarily participating in these activities with full awareness of the potential risks involved and assume full responsibility for my safety and well-being. I understand that any guided experience should not be attempted unsupervised or without appropriate training.


MEDICAL CERTIFICATION & DISCLOSURE

I certify that I am in good physical and mental health and will disclose all relevant medical information in the Medical Questionnaire provided by The Energy Studio. It is my responsibility to undergo necessary medical checks and consultations with a qualified healthcare professional before participating in any activities.


If I answer "YES" to any question in the Medical Questionnaire, I must provide a medical clearance certificate from a licensed healthcare professional issued within the last six (6) months. This may include:


  • Full medical examination and assessment of general health and fitness.

  • Cardiovascular assessment (blood pressure, heart rate, ECG).

  • Pulmonary function test and respiratory health assessment.

  • Any other necessary medical evaluations deemed relevant by a healthcare professional.


Failure to provide the required medical clearance or the identification of any condition that may compromise safety may result in denial of participation by The Energy Studio. The Energy Studio reserves the right to refuse participation at its sole discretion, even if medical clearance has been provided.

Medical Questionare

Please answer the following questions honestly and to the best of your ability. Your safety is our priority. If you answer "YES" to any question, you may be required to provide a medical clearance certificate from a licensed healthcare professional before participating.

General Health

Do you have any medical conditions that may affect your ability to participate in physical or breathwork activities? (e.g., heart disease, epilepsy, high blood pressure, asthma
Yes
No
Have you had any recent surgeries (within the last 12 months) or injuries that could impact your participation?
Yes
No
Do you have any chronic respiratory conditions (e.g., COPD, severe asthma)?
Yes
No

Cardiovascular Health

Have you ever been diagnosed with a heart condition or experienced chest pain during physical activity?
Yes
No
Do you have a history of high or low blood pressure that is not well-managed?
Yes
No
Have you ever experienced fainting, dizziness, or loss of consciousness?
Yes
No

Neurological & Mental Health

Have you ever been diagnosed with epilepsy, seizures, or any other neurological disorder?
Yes
No
Are you currently experiencing severe anxiety, depression, PTSD, or any other mental health condition that may be triggered by breathwork or meditation?
Yes
No
Are you currently taking any medications that may affect your ability to participate?
Yes
No

Pregnancy & Women’s Health

Are you currently pregnant or postpartum (within the last six months)?
Yes
No

Additional Considerations

Do you have any allergies or medical conditions that may require emergency medical intervention?
Yes
No
Do you have any other health concerns not listed above that may impact your participation?
Yes
No

INSURANCE & LIABILITY RELEASE

I acknowledge that:


  • The Energy Studio maintains general liability insurance; however, I am responsible for obtaining personal insurance coverage, including travel, medical, and accident insurance.

  • The Energy Studio, its directors, employees, instructors, agents, and contractors are not liable for any personal injury, illness, property damage, or loss sustained during or as a result of my participation.

  • I voluntarily waive, release, and discharge The Energy Studio from any and all claims, demands, actions, causes of action, liabilities, costs, and expenses arising from my participation.


I agree to indemnify and hold harmless The Energy Studio against any claims or liabilities arising from my actions during the activities.

ACKNOWLEDGEMENT OF NON-MEDICAL SERVICES

I understand and acknowledge that:


  • The Energy Studio does not provide professional medical, psychological, or mental health services.

  • The services offered are not a substitute for professional healthcare treatment or therapy.

  • None of the information provided in connection with the services shall be construed as medical, psychological, financial, legal, or professional advice.

  • I am responsible for seeking appropriate professional care when necessary.


PRIVACY & MEDIA RELEASE

I consent to:


  • The sharing of my health information disclosed in the Medical Questionnaire with The Energy Studio’s instructors and authorized personnel for safety purposes, in compliance with privacy laws.

  • The Energy Studio’s use, reproduction, and publication of any photographs, videos, or other media taken during activities for promotional, marketing, or educational purposes without compensation or further consent.

LEGAL AGREEMENT

If any provision of this waiver is found unenforceable or invalid, the remaining provisions shall continue in full force and effect.


By signing below, I acknowledge that I have carefully read this agreement, fully understand its contents, and voluntarily agree to its terms. I understand that I am waiving certain legal rights, including any rights my heirs, assigns, or beneficiaries may have.

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