Breathcamp In-Person FormPlease complete this form before you join us for our two day camp, Name * First Name Last Name Email * What date is your first session? * 1. What benefits would you like to gain from the session? * 2. Physical Issues: Have you had any recent surgery or health problems such as whiplash, a heart condition, a pacemaker, breathing difficulties, if you are pregnant, please give details here: * 3. Do you take medication or self medicate? If so, please give brief details: * 4. Do you have any particular emotions which predominate in your life, or any unresolved trauma that you are aware of? * 5. Where do you typically hold tension in your body? * 6. a) Do you have any preferred essential oil scents? b) Do you have essential oil scents you dislike or have allergies to? c) Do you have any allergies to base oils? * 7. Do you have any details of your birth that were significant e.g cord around neck, forceps delivery, separated from your mother? * 8. What experience of breathwork do you have? * 9. Anything else you would like to share that you feel is relevant? * * Yes, I have read Preparing for you Session and the Breathwork Terms and Conditions in the website footer. * I consent to Inspirational Breathing collecting, storing, and processing my personal information for the purpose of providing breathwork workshop services. This includes using my data to manage my workshop registration, communicate important information about the workshop, and ensure my safe participation. I understand that I can withdraw my consent at any time by contacting life@inspirationalbreathing.com. For more information on how we handle your data, please see our Privacy Policy. * I certify that I have taken medical advice relating to any physical, mental or emotional condition that may impair my judgment, or have any affect on my physical health in any way during or after a session. I understand and acknowledge that I am responsible for consulting my primary health care provider or a medical doctor in the event that I have or am suspect to have a health problem. I am encouraged by Inspirational Breathing to make my health care decisions in partnership with my medical doctor and/ or primary health care provider(s) on the basis of my own research regarding the effectiveness of breathwork sessions and the importance of diet, exercise, supplementation, stress management and emotional and mental work. I understand and acknowledge that, in undertaking a breathwork session with Inspirational Breathing, I am doing so at my own risk. It is with that understanding that I voluntarily execute this release and waiver. Thank you, your form has now been submitted!