"WOMEN BREATHE AWAY TRAUMA - RE-AWAKEN TO SELF-LOVE

*NOTE: Please use the comment box if necessary to fill out the answers to these questions. They are very important questions and must be answered with honesty.

There are some contraindications for the practice of Breathology. Furthermore, Breathology is a very powerful modality and
Certified Breathologist serve in a responsible way with standards and procedures that they commit to.

Thus, PositivEnergyWorks, LLC reserves the right to accept or reject any applicant based on the answers to these questions. “Thank you for your interest in PositivEnergyWorks, LLC™ and its services.

There is “Power in the Breath “ to Increase YOUR PositivEnergy™ ……..Sekou Ayo Handy-Kendi

Please Check If You: *

are pregnant. [Due Date] have ever been hospitalized for psychiatric or medical reasons are taking any medications. [Which?] are currently in therapy or any support group had complications at your birth (Caesarian, Late or Early born, Anesthesia, Multiple births, etc.) have attempted or seriously considered suicide [note details] are currently experiencing a “spiritual or emotional emergency” currently have an infectious or communicable disease

PARTICIPANT RELEASE STATEMENT

I do hereby agree to release Sekou Ayo Handy-Kendi, CEO and proprietor of PositivEnergyWork, LLC™ (PEW) its principals,
directors, agents, trainers, facilitators, contractors, advertisers, sponsors, and facility property owners and operators, and any
individual or organization associated with PEW from any and all liability for personal injury, or loss of, or damage to, personal
property or possessions of any individual attending or associated with PEW whether or not caused by negligence.

I further assume all risk of injury or loss from participation in the programs of PEW, including but not limited to: breathology,
breathwork, meditation, bodywork, healing touch, yoga, sound therapy, guided imagery/visualization, relaxation techniques,
laughter, EFT, ceremonies, rituals, toning, Reiki, essential oil aroma therapy, massage, reflexology, alternative/complimentary
therapies or any other form of participation in their course of study, instruction or experiential sessions.

I also approve of any form of touch, healing touch or physical massage and can not claim any sexual or personal harassment. I further understand that PEW assumes no liability for any program and/or product performance and if there are any concerns, it is recommended that I check with my physician, therapist or other licensed health care provider before engaging in any of the above-mentioned activities.

"WOMEN BREATHE AWAY TRAUMA - RE-AWAKEN TO SELF-LOVE' Online Registration Form

"WOMEN BREATHE AWAY TRAUMA - RE-AWAKEN TO SELF-LOVE'
Online Registration Form