• Aya Quest Native Americas Church NLLC (ANAC) "Heal at Home and Virtual Mushroom Ceremony" Release of Liability and Non Disclosure

  • I understand that risks associated with a ceremony and/or participation in Aya Quest Native Americas Church (ANAC) activities to include, but are not limited to, bodily injury, property loss or damage and death.

    By my signature below, on behalf of myself, my heirs, next of kin, successors in interest, assigns, personal representatives, and agents, I hereby:

    1. Waive any claim or cause of action against and release from liability ANAC, its clergy, volunteers, members, and agents for any liability for injuries to my person or property resulting from such entry and/or participation in ANAC activities;

    2. Agree to indemnify and hold harmless ANAC, its clergy, volunteers, members and agents for any claims, causes of action, demands, expenses, judgments, fees and costs of whatever kind or character arising from, by reason of, or in connection with my participation to a ANAC ceremony or participation in ANAC activities.

    I have carefully read this RELEASE AND INDEMNITY AGREEMENT, or had it read to me in a language I fully understand, and I understand all of the terms. I understand I have given up substantial rights by signing this agreement and that it is the intention of the parties that ANAC and its clergy, volunteers and members shall not be liable or in any way responsible for injury, damage, liability, loss or expense resulting to me due to accidents, mishaps, misconduct, negligence or injuries. My signature below has been made freely and voluntarily without any inducement, assurance or guarantee being made.
     

  • Clear
  • I understand that Steve and/or Teri Hupp and/or all persons named and unnamed involved with ANAC NLLC in any capacity, cannot be held liable for any exposure to the COVID-19 virus or any damages resulting from any participation and/or any interaction of any capacity with ANAC members/clergy and/or any persons and/or animals.

    By signing below I also understand that I am participating at my own risk and I agree any court action brought against ANAC, Clergy, or members named and unnamed, will be handled by Private Church Arbitration to be administered in Green County, Kentucky.

    I also understand and agree to this NON DISCLOSURE AGREEMENT about the ceremony and/or any ANAC interaction without written permission from ANAC to include, but not limited to, social media, news outlets of all media, and all internet communications.

    I agree to pay $5000.00 for the first violation plus Arbitration and/or Court costs and/or Attorney's fees to include collection costs for the 1st violation and to double with each violation thereafter. ( 2nd-$10,000, 3rd-$20,000, 4th=$40,000, and so on.)

  • Clear
  •  -
  • Should be Empty:
Jotform Logo
Now create your own Jotform - It's free! Create your own Jotform