Breathwork | O2&Ice

O2&Ice

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WHM Workshop
Breathwork

Sacred circles:

Date: 23. June. 2025

Time: 19.00-21.00

Location: Hands-on Health, 16 Victoria Road, Exmouth, UK

Google maps: https://maps.app.goo.gl/h6aHK24WCoye4QJ77

Pay here

Please complete Medical Waiver here:

Full Name *

Email *

Phone *

Date of your workshop *

Are you in good health? ex: can you play sports or go in a sauna without encountering any problems? *

yes
no

Do you, or have you ever suffered from any of the following conditions? *

heart disease
hypertension (high blood pressure)
hypotension (low blood pressure)
angina pectoris
epilepsy
Raynaud's Syndrome type ll
kidney failure
severe asthma
recently had an operation
migraines
schizophrenia
auto immune disease
any other serious medical conditions
none of the above

If you ticked 'any other serious medical conditions' please provide more information and consult your doctor if you have any questions before participation

Do you currently take medication for your heart *

yes
no

If you ticked 'yes' , please provide more info (what medication and what is it for)

Are you allergic to certain foods or substances? *

yes
no

If you selected 'yes' please describe which foods or substances you are allergic to

Are you currently pregnant? *

yes
no

Is there anything else your instructor should know?

I hereby declare that I completed this form accurately. I shall not hold Liviu Hrubariu or any of his assistants liable for any damages and/or injury resulting from participation in the activity. My participation is voluntary and at my own risk. *

I agree

I confirm I am over the age of 18 *

Yes

If you answered 'other' please give more info

I provide consent for my information to be used for the event I'm attending and understand I may occasionally be contacted about future WHM activities.(You can unsubscribe at any time). *

yes

Emergency contact. Please include the name and phone number for your emergency contact: *

Leave this field empty