Ceremony Waiver


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Question 1 of 7

Full Name, Date of Birth & emergency contact information.

Question 2 of 7

Do you have any medical conditions, if so, please be specific. Are you taking any medications? YOU CANNOT PARTICIPATE IF YOU HAVE BEEN TAKING ANTI-DEPRESSION MEDICATION.

Question 3 of 7

Do you have experience with plant medicine teachers such as Ayahuasca, San Pedro, Medicinal Mushrooms, Cannabis and other natural substances for the purposes of healing?

Question 4 of 7

In the home, there will be others going through this experience with you. Do you agree to be respectful of other’s and their questions/needs during the course of the ceremony and follow all the rules for this ceremony?


Yes, I agree

Question 5 of 7

For this event, it's recommended that you prepare by abstaining from animal products, alcohol, cigarettes and other substances that would hinder the natural healing process. Are you willing to undergo these recommendations at least one week before?





Question 6 of 7

Do you agree with our privacy terms, due to the nature of this plant medicine ceremony?  By this it means that you are in agreement of the personal cases or private information disclosed.This is a contract between you, the other participants and myself, the instructor. All things shared will be confidential.



Question 7 of 7

Because this event contains plant medicines that are not FDA approved, you must agree to take full responsibility for yourself during your experience. Results vary on individual efforts, as stated in the terms of service on this website. 


Yes, I agree.

Confirm and Submit