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Waiver and Release Form for
Group, Private Breathwork Sessions, and Online Course
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1. Releasees
For the purposes of this Release and Waiver, “Releasees” means The Lily Flower by Priyanka a registered business name owned by The Trustee for WP Calvert Family Trust (ABN 92 727 403 070), its directors Priyanka Saha and William Calvert, all employees, facilitators, contractors, agents and volunteers associated with the delivery of any The Lily Flower by Priyanka group, private sessions or online courses.
2. Health Contraindications
Do NOT participate in any breathwork sessions if you have any of the following conditions unless you have obtained written medical clearance:
- Schizophrenia, bipolar or other psychotic disorders, or any severe psychiatric condition
- Epilepsy or history of seizures
- Serious hearing conditions affecting balance or safety
- Pregnancy
- Serious cardiovascular issues (e.g. uncontrolled high blood pressure, recent heart attack)
- Abdominal aneurysm or untreated hernia
- Chronic Obstructive Pulmonary Disease (COPD)
- Serious or recent eye conditions (e.g. retinal detachment, glaucoma)
- Recent major surgery
- Current use of recreational drugs or medication that significantly alters brain chemistry
Participate ONLY WITH CAUTION (gentle approach) if you have:
- High or low blood pressure (managed)
- Asthma – bring your inhaler
- History of stroke or controlled heart conditions
- Severe anxiety or panic disorder
- Recent physical injury or surgery (consult your doctor first)
- Thyroid condition
- Diabetes – bring glucose source
- Recent eye surgery
If you have any other medical, physical, or psychiatric condition that could affect your ability to safely participate, you must inform the facilitator and obtain medical clearance. Participants are strongly advised to consult their GP or specialist if uncertain.
3. Acknowledgements & Assumption of Risk
- Breathwork sessions are complementary and not intended to replace medical advice or treatment.
- Sessions are not to be relied upon for prescriptions, diagnosis, or treatment of any health condition.
- Sessions may include physical touch and/or essential oils. I may revoke consent at any time by saying “stop”.
- I have disclosed all relevant medical conditions and medications to the facilitator.
- I accept responsibility for any consequences resulting from my participation.
4. Australian Consumer Law
Nothing in this document excludes, restricts or modifies any right or remedy, or any guarantee, warranty or term that cannot lawfully be excluded under the Competition and Consumer Act 2010 (Cth) or equivalent State or Territory legislation.
5. Release of Liability
To the fullest extent permitted by law, and except for liability that cannot be excluded, I release and discharge the Releasees from all liability for personal injury (including death), loss or damage arising out of or related to my participation in any The Lily Flower by Priyanka session, whether arising from negligence or otherwise.
6. Photography & Video
I consent to being photographed or filmed during sessions for promotional or educational purposes. If I do not consent, I will inform the facilitator before the session.
7. Governing Law
This Release and Waiver is governed by the laws of the State of Victoria, Australia, and the parties submit to the non‑exclusive jurisdiction of its courts.
8. Electronic Signature Consent
By typing my name below and submitting this form electronically, I confirm that this electronic signature is the legal equivalent of my handwritten signature under the Electronic Transactions (Victoria) Act 2000 and the Electronic Transactions Act 1999 (Cth). I agree this method of execution is valid and binding.
