Breathwork Training Registration Form

Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you practiced breathwork before? *

Yes

No

Are you currently a practitioner or professional in any related field? *

(e.g., yoga, therapy, coaching)

Yes

No

Do you have any medical conditions, injuries, or mental health considerations we should be aware of? *

(e.g., asthma, anxiety, pregnancy)

Yes

No

Are you currently taking any medications that may affect your breathwork practice? *

Yes

No

Please confirm that you are available for both live training days in London on the 6th and 7th September 2025 *

I confirm my availability for these dates

Photography and media consent *

I consent to having my image used in any photos or videos for promotional purposes.

I do not consent to having my image used in any photos or videos for promotional purposes.

Liability disclaimer *

I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in this course.

I agree