Disclaimer & Release of Liability

By signing below and taking this session(s), I hereby acknowledge that I understand any potential risks of
taking this breathwork session(s), workshop and/or program. It may cause without limitation the loss of
consciousness, dizziness, lightheadedness, tetany, and tingling sensations which can all pose a risk to my
health and well-being especially when unsupervised.

I acknowledge that I will ensure my own proper supervision, monitoring and/or safeguards when practicing at
home and release and forever discharge Mindful Soul Movement and Founder, Alexandra Burkowsky from all
actions, causes of action, damages, claims, and demands whatsoever arising out of the participation in the
breathwork session(s).

Breathwork is not advised for persons with a history of cardiovascular disease, including angina or heart
attack, high blood pressure, glaucoma, retinal detachment, osteoporosis, significant recent physical injuries or
surgery without first speaking with a medical professional.

Breathwork is not advised for persons with severe mental illness or seizure disorders or for person using major
medications. It is also unsuitable for anyone with a history of aneurysms. Pregnant women are advised to
consult with their primary healthcare physician and/or OB/GYN prior to practicing breathwork.

By signing below and taking this class, I acknowledge that I have read and agreed to the terms above, and if
necessary, consulted with my physician and/or healthcare provider prior to participation in this breathwork
session(s).

I understand that there may be pictures or video taken during the session for purposes of use which may
include social media or any type of advertising or promotion. If I do not consent to the use of media, or have
any questions, I will clearly make the facilitator aware prior to the session.