Consent and Signature:

By providing my signature below, I confirm that the information recorded above is complete, accurate, and honest to the best of my knowledge. I understand that Sacred Sacraments are not a replacement for medical treatment, and that the practitioner may only perform treatments within his or her scope of practice and level of comfort. Anything said during this session shall not be regarded as medical advice, treatment, diagnosis, or prescription. I understand that the therapist may refuse service at any time for any reason, and that clients may be referred to a medical professional if the practitioner feels this is necessary. I understand that it is my responsibility to inform the practitioner of any changes to my medical health profile and that the therapist will not be held liable for anything resulting from my failure to do so. I agree that I have been given sufficient opportunity to ask questions and make specific requests in order to make my treatment time as comfortable as possible. I have also read and will abide by all policies and client expectations that may be listed separately from this document. 

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT ("AGREEMENT")

In consideration of participating in BLUE LOTUS MEDICINE; INDIGENOUS SECRETS; SACRED INDIGENOUS SACRAMENTS; KAMBO SESSION & SACRED SACRAMENTS ("ACTIVITY" herein) I represent that I understand the nature of this Activity and that I qualified, in good health, and in proper physical condition to participate in such Activity. I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the Activity.

I fully understand that this Activity involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the "releases" named below, and that there may be other risks either not knows to me or not readily foreseeable at this time;

and I fully accept and assume all such risks and all responsibility for losses, cost, and damages I incur asa

result of my participation in the Activity.

I hereby release, discharge, and covenant not to sue BLUE LOTUS MEDICINE; INDIGENOUS SECRETS; SACRED INDIGENOUS SACRAMENTS; KAMBO SESSION & SACRED SACRAMENTS its respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the Activity takes place (each considered on of the "RELEASES" herein) from all liability, claims, demands, losses, or damages, on my account caused or alleged to be caused in whole or in part by the negligence of the "releasees" or otherwise, including negligent rescue operations and future agree that if, despite this release, waiver of

liability, and assumption of risk. I, or anyone on my behalf, makes a claim against any of the Releasees,I

will indemnify, save and hold harmless each of the Releasees from any loss, liability, damage, or cost, which any may incur as the result of such claim.

I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed if freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.