Release Liabilty
In consideration of the risk of injury while participating in CheyAnne’s events, kambo, ceremonies, microdsing or sessions, and as consideration for the right to participate in the activities,
I hereby, for myself, my heirs, executors, administrators, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the activity, and do hereby release and forever discharge any and all CheyAnne Curtis’s affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economic or emotional loss, that I may suffer as a direct result of my participation in the aforementioned activity, including traveling to and from an event related to this activity or event.
I understand that in order to participate in the circle or event safely, I was asked to follow a specific diet, omitting narcotics and alcohol for at least 4 days.
My signature below is a sworn statement that I did not abuse drugs or alcohol prior to sitting in the sacred circle or event.
By submitting this intake you agree and understand the following:
1. PAYMENTS AND CANCELLATIONS
Once these forms are siggned and submitted, CheyAnne will reach out to discuss if Kambo is right for you. If it is, payment for ceremony is due at the time of scheduling.
The session payments are non-refundable and non-transferable. You may reschedule your session with me 48 hours in advance if needed. *If you cancel any session less than 48hrs prior to your session, there are no exchanges for your treatment, you will no longer be able to use this session. If you need to change your appointment, I give a 48 hour grace period to change your session date within a 28 day period. If you do not reschedule within 28 days, you will lose your session with me.
2. ALL THE INFORMATION I HAVE GIVEN IS CORRECT
All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.
3. I have read all my pre and post, and all the info here and on this form on kambo. I agree to follow the Diet and how to prepare.
4. Please note that I am not licensed, certified, or registered as a provider of healthcare. The wellness services that I provide don’t constitute any form of medical practice, and don’t diagnose, treat, or offer health advice, nor prescribe medication. All material here is for educational purposes. It is recommended that you notify your primary care physician or licensed providers of healthcare of your intention to use other wellness services. It is also recommended that you ask your primary care physician or other licensed providers of healthcare about any potential drug interactions, side effects, risks, or conflicts between any medications or treatments prescribed by your primary care physician or other licensed providers of healthcare and the wellness services that you intend to receive.