Wild Heart Journeys, LLC offers breathwork, meditation, movement, and personal development experiences designed to support self-exploration, nervous system regulation, and personal growth.

These practices may involve deep breathing techniques, emotional processing, and physical sensations. Participants may experience temporary physical or emotional responses during these activities.

These sessions are intended for personal growth and education and are not medical, psychological, or therapeutic treatment and are not a substitute for professional healthcare.

Your Personal Information

First Name

Last Name

Email *

Phone *

phone

Emergency Contact Information

Emergency Contact Name

Emergency Contact Phone

Relationship to You

Health Acknowledgement

Contraindication Acknowledgement *

Contraindication Details

Assumption of Risk & Waiver

I understand that participation in breathwork, meditation, movement, and related activities involves inherent risks, including but not limited to dizziness, physical discomfort, emotional release, changes in breathing patterns, or other physical or psychological responses.

I voluntarily choose to participate and accept full responsibility for any risks, injuries, or damages that may occur as a result of my participation.

Release of Liability

To the fullest extent permitted by law, I hereby waive, release, and discharge Wild Heart Journeys, LLC and Nicole Gotthold from any and all liability, claims, demands, damages, or causes of action arising from my participation in these activities, including but not limited to personal injury, emotional distress, illness, or property damage.

I agree to indemnify and hold harmless Wild Heart Journeys, LLC and its representatives from any claims arising from my participation.

This waiver applies to all Wild Heart Journeys activities including in-person events, workshops, retreats, and virtual sessions.

Participant Responsibilities

By participating, I agree to:

• Follow all instructions provided by the facilitator
• Respect the privacy and confidentiality of other participants
• Participate at my own pace and within my personal limits
• Take responsibility for my physical and emotional well-being before, during, and after sessions

Consent & Acknowledgement

By signing below, I confirm that:

• I am at least 18 years of age or have parental/guardian consent
• I have read and understand this entire waiver
• I am signing voluntarily and understand that I am waiving certain legal rights

Governing Law

This agreement shall be governed by the laws of the Commonwealth of Massachusetts, and any disputes shall be resolved in the appropriate courts of Massachusetts.

People with asthma should bring their own inhaler and consult with their physician and breathing session instructor before participating.

Anyone experiencing an emotional or spiritual crisis or any person with a mental illness who is not in treatment or lacks adequate support.

Please note, this list is not exhaustive and we generally advise that if you have a question about a condition you may have that is not listed here, you consult a physician before participating in these breathing sessions.

I HAVE READ THIS WAIVER CAREFULLY AND UNDERSTAND ITS CONTENTS.

I AM AWARE THAT BY SIGNING THIS DOCUMENT, I AM WAIVING SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE RELEASED PARTIES.

Age verification *

I represent and warrant that I am at least eighteen (18) years of age and have the legal capacity to enter into this agreement.

Your Signature *

Clear

Communications & Marketing Consent

I agree to receive email and/or text communications from Wild Heart Journeys, LLC including updates, promotions, and marketing messages. I understand I can unsubscribe at any time by clicking the unsubscribe link in any email or by replying STOP to any SMS message. I understand that message and data rates may apply for SMS messages.

Email Communications Consent *

Yes, I consent to receiving email messages

SMS Communications Consent *

Yes, I consent to receiving SMS messages

Photo & Video Release

Photo & Video Release I understand that photographs or video may be taken during Wild Heart Journeys, LLC events, workshops, and retreats. By selecting Yes, I grant Wild Heart Journeys, LLC permission to capture and use photographs or video in which I may appear for educational, promotional, and marketing purposes, including websites, social media, email communications, and promotional materials for Wild Heart Compass, its collaborators, and venue partners. I understand that I may appear in group photos or video, including incidentally in the background, and that I will not receive compensation for the use of these materials.

If I prefer not to be photographed or recorded, I will notify the facilitator so reasonable efforts can be made to respect my privacy.

Video and Photo Participation Consent *

Yes, I consent to my photo and video being taken

WILD HEART JOURNEYS, LLC CONTACT INFORMATION:
Nicole Gotthold
Email: [email protected]

This waiver is effective for all Wild Heart Journeys, LLC breathwork activities for one (1) year from the date signed.Website: www.wildheartcompass.com