Before You Begin

Participation Waiver

Your safety matters. This waiver ensures you understand the nature of VEYA experiences and gives us the information we need to keep you safe.

Legally Secure

Electronic signature binding under state and federal law.

Safety First

Your medical info helps us tailor the experience to you.

Instant Record

Signed copy emailed to you immediately upon submission.

Why we ask for this information

Breathwork, cold exposure, and nervous system practices are powerful tools. They can also be physically and emotionally intense. Your medical history and emergency contact allow us to modify protocols, provide safer guidance, and respond appropriately if anything unexpected arises. This is not bureaucracy — it is care.

Medical screening

We check for contraindications before every session.

Protocol adaptation

Your conditions inform how we guide your breath or exposure.

Emergency readiness

Your contact is accessible if we ever need it.

Complete Your Waiver

Liability Release & Acknowledgment

All fields are required. Please read each acknowledgment carefully before checking.

Participant Information

Full Legal Name *

Email Address *

Date of Birth *

Phone Number *

Emergency Contact

Emergency Contact Name *

Emergency Contact Phone *

Experience Details

Experience Type *

Experience Date *

Medical Disclosure

List any medical, cardiovascular, respiratory, neurological, psychiatric, or mental health conditions. Also disclose if you are pregnant, recovering from injury, or taking medication.

Required Acknowledgments

You must check every box below to proceed. Read each statement carefully.

I represent that I am in good physical and mental health and do not have any condition that would prevent me from safely participating in VEYA experiences. I agree to inform VEYA of any changes to my health status.

I understand that VEYA practices may involve physical exertion, emotional release, altered breathing, nervous system activation, cold exposure, and shifts in mental or emotional state. I voluntarily assume all risks associated with participation.

I understand I am responsible for consulting a licensed healthcare professional before participating if I have any medical, cardiovascular, respiratory, neurological, psychiatric, or mental health conditions. I have been advised to seek medical clearance if I am pregnant, recovering from injury, have a history of seizures, or take medication.

I agree to discontinue participation immediately if I experience discomfort, distress, dizziness, pain, emotional overwhelm, or instability. I am solely responsible for monitoring my own physical and mental state.

I hereby release, waive, discharge, and covenant not to sue VEYA, its owners, instructors, facilitators, staff, volunteers, contractors, affiliates, and partners from any and all liability, claims, demands, and causes of action arising out of participation. I understand this covers negligence but not gross negligence or willful misconduct.

I understand that VEYA does not provide medical treatment, psychotherapy, psychiatric care, or licensed healthcare services. VEYA practices are not intended to diagnose, treat, cure, or prevent any disease, disorder, injury, or medical condition. All experiences are for wellness, educational, mindfulness, and personal development purposes only.

Digital Signature

Type your full legal name below. This constitutes your electronic signature and confirms you have read, understood, and agree to all terms above.

Type Your Full Legal Name *

Date

Your information is secure and never shared

Please complete all required fields and check all acknowledgment boxes.

By submitting this form, you acknowledge this is a legally binding electronic signature under applicable electronic signature laws. If you do not agree with any of the terms above, do not participate. Questions? Contact us.