Waiver of Liability

PLEASE READ THIS FORM CAREFULLY.
THIS IS A BINDING LEGAL DOCUMENT.

This release says that you know that participating in a religious ceremonial ritual that involves the ingestion of the Holy Sacrament Ayahuasca (also known as Daime) may involve discomfort and unexpected physical, mental, or emotional upset. By signing this release agreement, you are waiving all rights to seek or receive compensation in case of injury, loss, or damage.

I understand that the Church of the Celestial Heart, its facilitators, and its staff are, first and foremost, in charge of the safety and well-being of all participants. I further understand that in order to assist in this regard, I have agreed to complete this application process, including the medical history form and my personal information. I also agree to notify the church and its staff should there be any change in the information provided or in my health status before, during, or after ceremonies and prior to any subsequent ceremonies I might wish to join.

I understand that the information obtained herein is used to determine if it is appropriate for the undersigned to participate in this work. I realize that failure to disclose such information now and failure to provide updates of any changes in the future could result in serious harm to me or my fellow participants, and I agree to indemnify and hold harmless the Church of the Celestial Heart, its facilitators, and staff if all relevant information is not disclosed. I hereby declare that the information provided in these forms is a complete and accurate statement of the physical and psychological factors which may affect my participation in the ceremonies and will be used to determine if I am fit to join the church in its sacred rituals.

I understand that having any kind of history of mental disorders, psychosis, or psychotic episodes may make me even more susceptible to an adverse reaction in using the sacrament, Ayahuasca or Daime. I understand that it is my responsibility to seek the advice of a healthcare professional if I fall within this category and that I must inform the church and its staff. I understand and agree that these communications shall take place before any ingestion of the sacrament and prior to arriving to participate in a ceremony. (In this case, please direct any communication to the church contact person who has directed you here).

I understand that I am joining a religious ritual, and that the foundation of these ceremonies is inspired and originated in the Santo Daime and Umbandaime religions founded and originating in Brazil. I understand that the ceremony in which I choose to participate may be physically, mentally, emotionally, or spiritually demanding. I understand that I may experience dizziness, nausea, or other physical upsets, including vomiting and diarrhea.

During the ceremony, I will ingest an entheogen, the sacred sacrament known as Ayahuasca or Daime. This substance is a natural extract of plants that grow throughout the Amazon basin in South America. I have been informed of its effects as well as the objectives of taking it within the religious ritual led by facilitators of the Church. I have been attracted to the Church as a result of research, personal reports, and information, as well as the potential for a profound spiritual experience. I understand that the Church will make no claim or promise regarding the curing of any illness or the nature of any spiritual experience.

I understand that the work and experience within a ceremony are personal and sacred to each individual and that what may occur for one person may not necessarily lead to the same experience in others.

I understand that, although my participation in the ceremonies of the ‘Church of the Celestial Heart’ is purely voluntary, I agree to remain until the closing of the sacramental ritual I choose to begin.

I understand I may be physically or mentally exhausted and/or disoriented after the ceremony. I acknowledge that it is my responsibility to arrange alternate transportation, if needed, at the conclusion of the ceremonies and/or stay for the duration of recovery (overnight) to ensure my safety and that of others. I hereby knowingly and voluntarily assume the full risks of any physical or other injury, damage, or losses, either to myself or caused to others by me, during any of the ceremonies organized by or on the property of the Church of the Celestial Heart.

I accept full responsibility for anything that may occur, including emotional disturbance, mental disorientation, and any and all possible manifestations of physical, emotional, and mental changes. I acknowledge that the risks and potential benefits of my participation have been explained to me, and I freely choose to enter this process, accepting full responsibility for whatever may occur, anticipated or unanticipated.

I understand that the Church of the Celestial Heart holds all rights in allowing participation and reserves the right to deny participation if it sees a risk to me or any of the other participants at any time.

I hereby waive the liability of and agree to hold harmless the ‘Church of the Celestial Heart’, including all of its founders, staff, family, members, volunteers, associates, employees, agents, successors, and other participants. I further agree to defend and indemnify them from any claims, suits, and demands. I understand that this agreement is binding upon me, my spouse, parents, famly, heirs, executors, administrators, agents, and assigns.

 

I HAVE READ AND UNDERSTAND THIS WAIVER HAVE HAD TIME TO
REFLECT UPON IT, AND HEREBY SIGN THIS WAIVER VOLUNTARILY.