In advance of the workshop, please complete this and the medical form, and return to:
LYNDA CLOSE of Petrie, QLD 4502

COMMITMENT AND RELEASE FORM

I hereby acknowledge that I understand that the aim of the workshops and individual sessions provided by Lynda Close is one of deep self-exploration. Holotropic Breathwork in no way promise healing although therapeutic results may occur. I agree to participate fully in all aspects of the work, and I take full responsibility for all the effects of the processes used and any subsequent change in my life.

In consideration of being accepted to participate in the workshops or individual sessions conducted with Lynda Close, I agree:

1: that no illegal drugs will be brought to or used by me at the venue;

2: that I am responsible for my own health care;

3: that I will treat as strictly confidential whatever is personal to other participants;

4: that I will remain for the entire period of each workshop in order to complete the process; and should I wish to leave early, I agree to discuss this with the group facilitator;

5: that, should the facilitators decide that the workshop is not appropriate for me, there will be mutual dialogue. They have the right to terminate my participation & may choose not to disclose the reasons for termination, provided registration fees are refunded to me, less the deposit;

6: that I will undertake not to use any of the processes, skills or techniques without supervision of a suitably qualified Holotropic Breathwork® facilitator until completing the training course for practitioners;

7: I have read and have indicated on the attached Confidential Medical Information Form any conditions from which I suffer or have suffered, including medications taken. Where requested, I have provided a medical certificate confirming my suitability for participation.

8: I shall participate in workshops or individual sessions with Lynda Close entirely at my own risk;

9: I hereby release Lynda Close from all or any liability to myself or to any other person for injury, death, loss or damage to me or to my property howsoever or wheresoever occurring during or as a consequence of my participation in workshops or individual sessions with Lynda Close

10: I hereby indemnify and hold harmless Lynda Close against all or any claims, suits, proceedings, actions or demands for loss, injury or damage to person or property howsoever or wheresoever occurring during or as a consequence of my participation in workshops at Brisbane International Hotel - Virginia

11: I list briefly below any types of inner work I have done previously:

Before signing this commitment and release form, please also complete the medical form, provide the necessary information (and medical certificates if required) and sign it.

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