Self Responsibility Reclamation – Breathwave for Teens

This is an important document – make sure a parent/trusted caregiver reviews it with you.

I understand that there may be safe physical touch involved in the Breathwave style of Conscious Connected Breathing. If I feel okay with it, I can give Christy MacLean (“Christy”) permission to use gentle touch the way she’s been trained. This is always meant to help me feel comfortable and supported.

If at any point I want to say yes or no to getting help with my breathing, I’ll let Christy know, either by telling her or giving a signal.

I get that this breathing practice is powerful and can help clear out old feelings, stress, or stuff I’ve been holding onto. I know that things like emotions, thoughts, memories, or beliefs might come up, and that’s just my body and mind healing.

I’m responsible for what I feel and experience during Breathwave.

I understand that I can control how strong the practice feels for me. If it feels like too much, I can always slow my breath down, especially when I breathe out, to make things easier.

Whatever comes up during this breathing is part of my healing.

I agree to listen to Christy because she’s the coach and knows how to help keep things safe for everyone. I’ll follow her advice so things go well for me and the group.

I know that Breathwave can make my body or mind feel different, like having a faster heartbeat, feeling warmer or cooler, or getting tingly muscles. I might also feel really relaxed, help my body get rid of toxins, or just feel healthier overall.

I promise to do Breathwave without using drugs, alcohol, or anything else that changes how I feel.

I don’t have any health or mental issues that would stop me from joining in. If I have any worries now or in the past that could affect me, I’ll let Christy know so she can help keep me safe. I’ll tell her about any medical stuff that might need special attention (and I can write these down if I want).

I know that sometimes this kind of breathwork can make me feel like I’m in a different state of mind. If I’ve had mental health challenges, I’ll make sure to talk to Christy about it so she knows and we can be careful together.

I agree that I’m choosing to do all these exercises at my own risk, and I won’t blame Christy if something happens to me, unless it’s because of something really careless she did.

I know that Christy can ask me to leave the session if she thinks I’m not being safe, acting appropriately, or if I’m putting myself or anyone else at risk.

Please complete: