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Sonic Neural Breathwork Experience

Do you currently have or experience any of the following? Check all that apply.

If any of these apply to you please refrain from participating:

- Severe heart issues or pacemaker

- Seizures or epilepsy 

- Severely prone to fainting or passing out  

- Severely low or uncontrolled blood pressure  

- History of Severe Panic attacks 

- Psychosis, fragile psyche, or schizophrenia 

- Pregnancy 

Informed Consent, Assumption of Risk, Liability Waiver, and Hold Harmless I, the undersigned, desire to voluntarily participate in the SONIC NEURAL BREATHWORK the primary focus which is healing through breathwork. I represent that I am knowledgeable of this event and the risks of personal injury or property damage to myself and to others which may be associated with the event, including but not limited to bodily injury including strains. I knowingly and voluntarily assume the risk of any injuries, regardless of severity, and including death, all risk of damage too or loss of property which I may incur due to negligence or accidental occurrences while I am participating in this event. On behalf of myself, my agents, heirs and next of kin, I hereby release and hold harmless Mariska Swartz and their respective agents, employees, next of kin and representatives from any responsibility or liability for personal injury, death, or damage to or loss of property that I may incur while I am participating in this event.

Pleae select one of the above:

Thanks for submitting!

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