KAMBO 11OUSE WAIVER

Disclaimer:

Kambo is the secretion from the Phyllomedusa bicolor frog. Traditionally, Kambo is used by indigenous peoples of the upper Amazon to lift Panama (dark or negative energy) and for Hunting “Magic.” Your practitioners, Julie Chavez and Billy Ward, have been trained by the IAKP (International Association of Kambo Practitioners). Your practitioners are not licensed in the medical field and does not diagnose or prescribe any medications for any conditions nor does she diagnose, treat, or cure any medical conditions. Kambo treatment should not be used as a substitute for medical care and advice from your physician. Please contact a qualified, licensed physician for any illness or disease.

In consideration for being allowed to participate in the Kambo treatment, I agree to the following:*

I have read the information sheet provided by the practitioners and will follow the guidelines. I am aware that there is no obligation for them to provide me with medical care during this treatment. I accept full responsibility for any risks associated with participation in this treatment.I agree to stay for the duration of the session (approximately 1 - 1.5 hours) and will not leave the premises until instructed by the practitioner that it is permissible to do so. I hereby acknowledge that if I am required to use an automobile to travel to and from the session, I will not drive until the effects of the treatment have completely subsided. I accept full responsibility for the automobile and the use of the automobile will be at my own risk.I agree not to consume alcohol or recreational drugs, including marijuana, within 2-3 days of receiving Kambo; this applies to both before and after treatment.I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY (reimburse for any loss including any reasonable legal fees they may incur), AND HOLD HARMLESS THE ORGANIZER AND KAMBO PRACTITIONER, their officers, officials, agents and/or employees, other participants, and, if applicable, owners and lessors of premises used forthe Kambo treatment ceremony. (“RELEASED PARTIES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASED PARTIES OR OTHERWISE, to the full extent permitted by law. I KNOWINGLY AND FREELY ASSUME ALL RISKS, both known and unknown, EVEN IF ARISING FROMTHE NEGLIGENCE OF THE RELEASED PARTIES or others, and assume full responsibility for my participation; and I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS,UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.I have accurately and fully completed and read a Confidential Participant Information Form and made full disclosure of my current and past medical and psychiatric conditions, including prescription drug use, recreational drug use, and alcohol use. I certify that I am not suffering from any undisclosed physical or psychiatric condition and have not decided to stop the use of prescribed medication in order to participate in this Kambo treatment without consulting my physician. I understand that the below conditions are contraindicated for receiving Kambo and that Kambo used in conjunction with the below conditions can result in serious medical problems, mental health problems, or death. I further certify that none of the following conditions apply to me currently or in the past:

Stroke.

Heart bypass surgery.

Enlarged heart.

Implanted cardioverter defibrillators.

Congestive heart disease.

Excess fluid in the heart sac.

Heart valve replacement surgery.

Organ transplant.

Aneurysm.

Active ulcers.

Addisons Disease.

Ehlers Danlos Syndrome.

Any previous Oesophagus/Esophagus bleeding or rupture.

Have had a psychotic episode in the past 5 years.

Brain hemorrhage.

Blood clots.

Epilepsy.

Recovering from a major surgical procedure.

Serious mental health conditions, excluding depression, PTSD, and anxiety.

Lack the mental capacity to decide to take Kambo.

Seriously low blood pressure that requires medication.

Pregnant or breastfeeding women with babies under 6-months old.

Within 21 days of giving birth.

Undergoing chemotherapy or radiation treatments (and 6 weeks afterwards).

Not currently taking slimming or sleeping supplements.

Do not have an active drug or alcohol addiction.

Any previous Oesophagus/Esophagus bleeding or rupture.

I agree to notify the practitioner VIA EMAIL if there have been any changes since the original Confidential Client form was completed, signed and submitted, prior to any future sessions.

Have not fasted for 7 days before the appointment and will not fast for 7 days afterwards.

I have not done colonics, enemas or liver flushes 3 days prior to this treatment and will not do so for 3 days afterwards.

I have not done any water-based fasting 7-days prior to this treatment and will not do so for 7-days afterwards.

** **THIS IS NOT TO BE CONFUSED WITH THE “ONLY WATER PERMITTED” FASTING YOU WILL DO 8-HOURS PRIOR TO YOUR SESSION (you can have water during the 8-hours prior to Kambo but not excessive amounts). You will be instructed by me to drink 1.5-2-liters of water about 10-20 minutes before I place the Kambo on. It is STRONGLY ADVISED that you do not drink more than 4 liters of water during your treatment, including 2-hours before, during, and after your treatment.

Cautions (MUST DISCLOSE IF ANY OF THE BELOW PERTAIN TO YOU):

People taking dieting or sleeping supplements.

Active drug or alcohol addiction.

Crohn’;s Disease/Irritable Bowel Syndrome (IBS).

Severe liver disease.

Severe injury or trauma to the Oesophagus/Esophagus from endoscopy.

Tumors in the throat.

Ulcers in the throat.

Physical trauma or injury to the neck (OFTEN CAUSED BY CAR OR MOTORBIKE ACCIDENTS).

Those who have, or have had in the past, Bulimia.

Gastro-intestinal Reflux.

Chronic inflammatory response syndrome due to mold exposure.

Untreated eosinophilic esophagitis.

Violent/Projectile vomiting.

Esophagus/Esophagus Varices.

Portal Hypertension.

Taken Bufo/5MeO-DMT within 28-days.

Do not fast for 7 days before or after taking Kambo.

Colonics, enemas and liver flushes should be avoided within 3 days before and after taking Kambo. Water-fasting should be avoided within 7 days before and after taking Kambo (THIS IS NOT TO BE CONFUSED WITH THE WATER-ONLY FASTING YOU WILL DO 10-HOURS PRIOR TO YOUR SESSION).

You can have water, but not excessively, during this time). You will be instructed by me to drink 1.5-2-liters of water about 10-20 minutes before I place the Kambo on.

It is STRONGLY ADVISED that you do not drink more than 4 liters of water during your treatment, including the 2 hours both before and after.

Do not consume alcohol or other recreational substances 24-48 hours before or after your treatment.

During menstruation (Women on their period are more comfortable if they avoid Kambo. It can increase bleeding and cramping and can often cause lightheadedness and sometimes even fainting).

Oesophagus/Esophagus Rupture

Since Kambo can cause vomiting, I need to have some caution around certain conditions that could weaken the Oesophagus/Esophagus. These do not necessarily preclude you from experiencing Kambo, but it is advisable to make sure to let me know if you have been affected with any of the following:

Boerhaave’s Syndrome (spontaneous rupture of the esophagus).

Severe injury or trauma to the Oesophagus/Esophagus from endoscopy or injury to the neck.

Tumors or ulcers in the throat.

Bulimia currently or in the past.

Gastro-intestinal reflux.

Chronic inflammatory response syndrome due to mold exposure.

Untreated eosinophilic esophagitis.

Oesophagus/Esophagus Varices.

Portal Hypertension.

IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT I HAVE READ AND UNDERSTAND THE ABOVE AND SIGN VOLUNTARILY; I AM, AT LEAST, (18) YEARS OF AGE AND FULLY COMPETENT; I EXCUSE THIS RELEASE

FOR FULL AND COMPLETE RELEASE OF LIABILITY.

Name*

First NameLast Name

Signature*

Date Signed*

Date

Kambo Contraindications

Kambô is very safe but should always be taken with a properly trained practitioner administering and supervising the treatments at all times. Certain health conditions prevent some people from taking Kambô just like some situations require special precautions. Please read carefully the following lists, it is very important that you disclose your whole health history with your practitioner. If something is not clear or you don’t understand, please ask..

Contraindications

The following may not safely take Kambô:

People with serious heart problems
People who have had a stroke
People on medication for low blood pressure (this is extremely rare)
People who’ve had a brain hemorrhage
People who have aneurysms or blood clots
People who lack the mental capacity to make the decision to take Kambo
People with serious mental health problems excluding depression and anxiety
People undergoing chemotherapy or radiotherapy for 4 – 6 weeks afterward
People who take immune-suppressants for an organ transplant
Women who are pregnant or may be so
Women who are breast-feeding a child under 6 months old
People with Addison’s disease
People with Ehlers Danlos Syndrome
People with current and severe Epilepsy
Are recovering from a major surgical procedure
Under 18
Animals

Caution is also required in the following cases:

People taking immune-suppressants for autoimmune disorders.
Active drug or alcohol addiction.
Long term or water fasting for 7 days before or after Kambo other than the required fasting.
Colonics, Enemas, liver flushes or any water based detox should be avoided within 3 days either side of taking Kambo.
If someone has taken Bufo 5-MeO-DMT there is a 6-8 week waiting period before Kambo.

Oesophagus/Esophagus Rupture
Because Kambo can cause violent vomiting we need to have some caution around certain conditions that could weaken the Oesophagus/Esophagus. These do not necessarily preclude you from experiencing Kambo but it is advisable to make sure to let your Practitioner know if you have been affected with any of the following:

Boerhaave’s Syndrome (spontaneous rupture of the esophagus)
Severe injury, or trauma to the Oesophagus/Esophagus from endoscopy, or injury to the neck.
Tumors, or Ulcers in the throat
Those who have or have had bulimia
Gastro-intestinal Reflux
Chronic inflammatory response syndrome due to mold exposure
Untreated eosinophilic esophagitis
Oesophagus/Esophagus Varices
Portal Hypertension