Please answer the following questionnaire.
Please tell us if you have any disease, pathological or functional problem not considered here.
All the information provided will be kept private.
IMPORTANT By clicking the SEND FORM button on the bottom you agree to the following terms :
I understand that shamanic work may include the use of traditional healing plants. I agree that I always have a choice whether or not to participate, and I agree to take full responsibility for the choices I make involving this work, both during and after the event. To the best of my knowledge, I am in good physical condition and I am not aware of any physical, physiological, or psychological infirmity which would place me at risk to participate in any way within the ceremony activities. I take full responsibility for my own belongings and safe transportation to and from the ceremony/workshop.
I understand that the facilitators reserve the right to deny my participation if they deem that it would be unsafe for me, or for others, or for any other important reason. I agree to listen and follow the instructions given by the facilitators. I take full responsibility for any damage that I may cause to the facility that is used for the ceremony.
To maintain the safety, trust and respect for all participants, I agree to hold this work confidential. I will not reveal to anyone the identity of those who are participating in the event. This includes maintaining confidentiality for all facilitators, helpers, shamans or healers who are also participating in the ceremony. I hereby RELEASE, WAIVE, DISCHARGE AND COMMIT NOT TO SUE the event leader, organizers and/or participants for any and all liabilities, claims, demands arising from or related to the event. I agree to participate with the purest intention of heart, promoting the health and well-being of all participants.
In signing this release (Clicking the Send Form button), I acknowledge and represent that I have read and understand the above and sign voluntarily; I excuse this release for full, adequate and complete release of liability.