DECLARATION OF HEALTH STATUS AND LIABILITY

(Participation at Own Risk)

  1. Participant Identification (Client)

Full Name: _______________________________________

Date of Birth: ______________

Address: __________________________________________________________________

  1. Health Status Declaration

I, the undersigned, hereby solemnly declare that:

  • My current state of health allows me to fully participate in a gentle relaxation, breathwork, and experiential program focused on personal development and stress reduction.
  • I do not suffer from any serious medical conditions (e.g., severe heart conditions, uncontrolled high blood pressure, epilepsy, or acute musculoskeletal injuries) that could present a risk to my life or health during the activities.
  • If I have suffered a serious illness or injury in the past, I have consulted my participation in the program with my attending physician, who approved this activity.
  • Women: I declare that I am not pregnant. If pregnant, I will inform the instructor immediately, and all risks associated with my participation in the program and related activities are borne entirely at my own responsibility and risk.
  1. Agreement to Terms and Assumption of Liability
  • Own Risk: I acknowledge that all relaxation and breathwork practices are undertaken entirely at my own risk and responsibility.
  • Risks: I am aware that participation carries inherent risks of minor physical discomfort or injury. The instructor and operator accept no liability for any harm to health or property resulting from standard activities or improper execution of exercises by the client.
  • Instructor’s Instructions: I undertake to fully follow all instructions given by the instructor. In case of any uncertainty regarding any activity, I commit to asking for immediate clarification.
  • Duty to Inform: If any health issues arise during participation (such as nausea, pain, or dizziness), I am obligated to inform the instructor immediately and cease the activity.
  • Damages: I am liable for any damage I cause to the venue’s equipment or to other participants through my actions.
  1. Personal Data Protection (GDPR) 

I consent to the processing of my personal data for client record management. Furthermore, I explicitly consent to the processing of health-related data provided in this declaration solely for ensuring my safety and health protection during the program, in accordance with GDPR and the Privacy Policy published at www.yolenka.com. My health data will never be disclosed to third parties.

In ________________________  on ________________________

Client Signature: __________________________________________ (Legal guardian if under 18)