I hereby assume all of the risks of participating in any/all activities associated with Chaka-Runa, including by way of example and not limitation, any risks that may arise from; negligence or carelessness on the part of the persons or entities involved, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. 

 

I certify that I am physically and mentally healthy, apt and in good condition, and have thoroughly prepared for my participation in this Program, which includes the use of Plant Medicine, Kambo, Rapé and Sananga and the intake of other Master Plants.

 

I confirm that I have not been advised to not participate by a qualified medical professional. I certify that there are no health or mental-related reasons or problems which preclude my participation in this Program. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the Program in which I may participate, and that it will govern my actions and responsibilities during the Program. 

 

In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this Program, the following entities or persons: Chaka-Runa and/or their directors, officers, employees, volunteers, assistants, representatives, and agents, and the activity holders, and sponsors, (B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this Program, whether caused by the negligence of release or otherwise. 

 

I acknowledge that Chaka-Runa, and their directors, officers, volunteers, assistants, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. 

I acknowledge that this activity may challenge a person's physical, emotional and mental limits and carries with it the potential for death, serious injury, emotional and mental trauma, and property loss. The risks include, but are not limited to, those caused by the use of Plant Medicine, Master Plants, Kambo, Rapé, Sananga, Native Plants baths, flora and fauna, terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, assistants, and/or organizers and producers of the Program. These risks are not only inherent to participants, but are also present for everyone that partakes on any/all Programs.

 

I hereby consent to receive medical treatment at my own expense which may be deemed advisable in the event of injury, accident, and/or illness during this Program. I understand while participating in this Program, I may be photographed and recorded. I agree to allow my photo, video, or film to be used for any legitimate purpose by the Program holders, producers, sponsors, organizers, and assigns. 

 

The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. 

 

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND AND ACCEPT ITS CONTENT AND I SIGN IT ON MY OWN FREE WILL IN APPROVAL.