informed consent and release

  • Informed Consent and Release for Participation in a Kambo Session, Event or Retreat:

    By making this purchase, I have determined to participate in the ancient and traditional healing properties of a Kambo session, event or retreat. This is an ancient medicine of indigenous native tribes of the Amazon basin. Ancient peoples revere Kambo to “reboot” and heal body systems and functions, and to dramatically enhance mood and spiritual well-being. In the U.S., the Federal Drug Administration (FDA) determines if a drug or compound is “safe and effective”; the FDA has never studied or made a determination on Kambo. Known side effects from taking Kambo are anecdotal, but include nausea, dizziness, temporary elevated heartbeat/blood, flushing, vomiting, diarrhea, and serious interaction with most drugs and medications. Interaction with other drugs, or underlying serious health conditions could combine to cause serious medical conditions. I have been advised to consult with a medical doctor before proceeding, and have either done so, or wish to proceed without so doing.

    In exchange for participation in this Kambo Session, organized and administered by Kambo Healing Me (the “Releasee”), I (the ““Releasor”), hereby agree as follows:

    1. I and anyone claiming on my behalf release and forever discharge Releasee and its affiliates, successors and assigns, officers, employees, representatives, partners, suppliers, agents and anyone claiming through them (collectively, the “Released Parties”), in their individual and/or corporate capacities from causes of action of any nature and kind, known or unknown, which I may have against Releasee or any Released Parties arising out of or relating to any injury, loss, or damage to person and property that may be sustained as a result of participation in the Activity (“Claims”).

    2. I understand that participation in the Activity has inherent risks, including risks of physical or psychological injury, pain, suffering, illness, disfigurement, and I assume all related risks and voluntarily participate in the Activity.

    3. I agree to indemnify Releasee against any and all claims, actions, lawsuits, damages, and judgments, including attorney’s fees arising out of or relating to my participation in the Activity.

    4. This Release for Participation in Activity (“Release”) should not be in any way construed as an admission by the Releasee that it has acted wrongfully with respect to me or any other person, that it admits liability or responsibility at any time for any purpose, or that I have any rights whatsoever against the Releasee.

    5. This Consent and Release shall be binding upon the parties and their respective heirs, administrators, personal representatives, executors, successors and assigns. I have the authority to release the Claims and have not assigned or transferred any Claims to any other party. The provisions of this Consent and Release are severable. If any provision is held to be invalid or unenforceable, it shall not affect the validity for enforceability of any provision. This Consent and Release constitutes the entire agreement between the parties and supersedes any prior oral or written agreements or understandings between the parties concerning the subject matter of this Consent and Release. This Consent and Release may not be altered, amended or modified, except by a written document signed by both parties. The terms of this Consent and Release shall be governed by and construed in accordance with the laws of the state of California.

    6. I have carefully read and fully understand all the provisions of this Consent and Release and am freely, knowingly and voluntarily entering into this Consent and Release.

  • Date Format: MM slash DD slash YYYY

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