Please read this document carefully before signing. By signing, you acknowledge that you have read, understood, and agreed to all terms.

1. Nature of Breathwork & Coaching

Breathwork and somatic coaching are experiential practices that involve conscious, controlled breathing techniques. During sessions, participants may experience physical sensations, altered states of consciousness, emotional releases, tingling, muscle tension, lightheadedness, or other responses. These are generally normal parts of the process and typically subside quickly.

Coaching services involve reflection, accountability, and personal development. Neither breathwork nor coaching is a substitute for licensed medical or mental health treatment.

2. Health Disclosure & Medical Screening

I confirm that I have disclosed any and all medical and mental health conditions that may be relevant to my participation. I understand that the following conditions may contraindicate breathwork participation, and I have consulted a licensed healthcare provider if any apply to me:

• Cardiovascular conditions, including heart disease, hypertension, or history of stroke

• Epilepsy or seizure disorders

• Pregnancy

• Severe respiratory conditions (e.g., COPD, severe asthma)

• Active psychosis, schizophrenia, or dissociative disorders

• Recent major surgery or injury

• Severe anxiety, panic disorder, or PTSD (without provider clearance)

• Any condition for which intense physical or emotional experience may pose risk

By signing below, I confirm that I am medically and psychologically cleared to participate or have received written clearance from my licensed healthcare provider.

3. Assumption of Risk

I voluntarily participate in breathwork and/or coaching services offered by REC Ripple Effect Coaching LLC and Balanced Breathwork. I understand and accept that participation involves inherent risks, including but not limited to physical discomfort, emotional intensity, dizziness, and in rare cases, fainting. I voluntarily assume all such risks.

4. Release of Liability

In consideration of being permitted to participate, I hereby release, waive, discharge, and covenant not to sue REC Ripple Effect Coaching LLC, Balanced Breathwork, Dominique Ziegler, and their respective officers, employees, agents, contractors, successors, and assigns (“Released Parties”) from any and all liability, claims, demands, actions, or causes of action

arising from my participation, including injury, illness, death, or property damage, whether caused by negligence of the Released Parties or otherwise, to the fullest extent permitted by law.

5. Emergency Authorization

In the event of a medical emergency, I authorize the facilitation team to call emergency services (911) on my behalf. I understand that REC Ripple Effect Coaching LLC does not provide medical services and that facilitators are not licensed medical professionals.

6. Confidentiality & Privacy

REC Ripple Effect Coaching LLC maintains participant confidentiality. Group session participants agree not to disclose the personal information, stories, or sharing of other participants outside the session space.

5. Emergency Authorization

In the event of a medical emergency, I authorize the facilitation team to call emergency services (911) on my behalf. I understand that REC Ripple Effect Coaching LLC does not provide medical services and that facilitators are not licensed medical professionals.