JOURNEY TO YOUR SACRED HEART COSTA RICA RETREAT

Full Legal Name (as it appears on your ID)*

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DOB:*

Date

RETREAT PARTICIPANT AGREEMENT, RELEASE OF LIABILITY & ASSUMPTION OF RISK

Retreat Name: Journey to Your Sacred Heart
Location: Goddess Falls at Holos Diamanté Valley, Costa Rica
Retreat Dates: October 4th, 2026 - October 11th 2026
Organizer: MARINER WELLNESS INSTITUTE INC., a business operating under the laws of the State of California, USA

Retreat Center: HOLOS Collective, S.R.L.

1. AGREEMENT TO TERMS
By signing this Agreement, I acknowledge that I have carefully read, understood, and agree to be legally bound by its terms. I understand that this document is intended to be a complete and unconditional release of liability and waiver of legal rights to the fullest extent permitted by law.

2. VOLUNTARY PARTICIPATION
I voluntarily agree to participate in a retreat that may include, but is not limited to:

Yoga, movement, and physical activity
Breathwork and meditation practices
Emotional processing and group work
Spiritual development practices
Plant medicine ceremonies (optional participation)
Outdoor excursions, including waterfall activities
Accommodations (glamping tents, shared bathrooms)
Meals and group transportation

I understand that participation is voluntary and that I may decline any activity at any time.

3. EXPRESS ASSUMPTION OF RISK
I acknowledge that participation in the retreat involves inherent risks, including but not limited to:

Physical injury, illness, or medical emergency
Emotional or psychological distress
Risks associated with altered states of consciousness
Environmental hazards (terrain, wildlife, weather, insects)
Travel risks, including transportation incidents in a foreign country

I UNDERSTAND THAT THESE RISKS MAY RESULT FROM THE ACTIONS, INACTIONS, OR NEGLIGENCE OF THE RELEASED PARTIES OR OTHERS, AND I EXPRESSLY AND VOLUNTARILY ASSUME ALL SUCH RISKS, WHETHER KNOWN OR UNKNOWN, FORESEEABLE OR UNFORESEEABLE.

4. MEDICAL DISCLAIMER AND FITNESS TO PARTICIPATE
I represent and warrant that:

I am physically and mentally fit to participate
I have fully disclosed all relevant medical, psychological, and medication information
I am solely responsible for consulting a licensed healthcare provider prior to participation if needed

I understand that:

The Organizer does not provide medical, psychological, or licensed therapeutic services

This retreat is not a substitute for professional medical or mental health care

5. BREATHWORK AND ALTERED STATE PRACTICES
I understand that breathwork and similar practices may result in:

Dizziness, tingling, or hyperventilation
Emotional release or distress
Altered states of consciousness

I voluntarily assume full responsibility for my participation.

6. PLANT MEDICINE ACKNOWLEDGMENT
I acknowledge that certain optional retreat activities may include participation in plant medicine practices that are legal within the jurisdiction in which they are offered (Costa Rica).

I understand that:

These practices may produce intense physical, emotional, or psychological effects

Participation is entirely voluntary

These practices are not supervised by licensed medical or mental health professionals

They are not intended to diagnose, treat, or cure any condition

I further understand that while such practices may be lawful in Costa Rica, laws differ by country and jurisdiction, and I am solely responsible for understanding and complying with any laws applicable to me.

I acknowledge risks, including but not limited to:

Nausea, vomiting, or physical reactions
Emotional or psychological distress
Unpredictable altered states of consciousness

I confirm that:

I have disclosed all relevant health information

I have had the opportunity to ask questions and provide informed consent

I voluntarily choose to participate and accept full responsibility

TO THE FULLEST EXTENT PERMITTED BY LAW, I EXPRESSLY ASSUME ALL RISKS AND RELEASE THE RELEASED PARTIES FROM ANY AND ALL LIABILITY ARISING FROM OR RELATED TO MY PARTICIPATION, INCLUDING ANY ADVERSE OUTCOMES.

7. TRAVEL AND TRANSPORTATION
I understand that:

One scheduled shuttle will be provided from San José International Airport (SJO) on October 4
Return transportation will be provided on October 11
I am solely responsible for arriving on time. If I miss transportation, I am responsible for arranging and paying for my own travel.

8. ACCOMMODATIONS AND CONDITIONS
I understand that lodging includes glamping tents with shared facilities and exposure to natural elements, including weather and insects. I accept these conditions.

9. PAYMENT TERMS
A deposit or full payment is required to secure participation. Remaining balances must be paid in full by October 1. Failure to complete payment may result in forfeiture without refund.

10. CANCELLATION AND REFUND POLICY
We understand that life can be unpredictable, and we deeply honor the intention behind your commitment to this experience. At the same time, retreat planning requires advance commitments and coordination, and this policy helps us hold the container with integrity for all involved.

I understand this and agree to the following:

Deposits and Payments: A deposit is required to secure your spot.

Deposits are non-refundable.

Full balance is due by October 1st, 2026.

Cancellation by Participant:

90+ days before retreat: Deposit is non-refundable

60–89 days before retreat: 50% of the total retreat cost may be refunded

Less than 60 days before retreat: No refund

Missed Arrival or Early Departure: No refunds or credits will be issued for late arrivals, missed transportation, or early departure.

Organizer Cancellation: In the unlikely event the Organizer cancels the retreat due to unforeseen circumstances (natural disasters, government restrictions, etc.), payments may be refunded in full or applied toward a future retreat. The Organizer is not responsible for independent travel or accommodation expenses incurred by participants.

8. TRAVEL INSURANCE
I acknowledge that I am responsible for obtaining my own travel and medical insurance.

9. RELEASE OF LIABILITY

TO THE FULLEST EXTENT PERMITTED BY LAW, I HEREBY IRREVOCABLY RELEASE, WAIVE, AND DISCHARGE MARINER WELLNESS INSTITUTE INC., HOLOS COLLECTIVE, S.R.L., AND ALL RELATED PARTIES ("RELEASED PARTIES") FROM ANY AND ALL CLAIMS ARISING OUT OF OR RELATED TO MY PARTICIPATION, INCLUDING CLAIMS ARISING FROM THE NEGLIGENCE OF THE RELEASED PARTIES.

THIS INCLUDES CLAIMS FOR PERSONAL INJURY, ILLNESS, EMOTIONAL DISTRESS, DEATH, OR PROPERTY DAMAGE.

10. COVENANT NOT TO SUE

I AGREE THAT I WILL NOT INITIATE ANY LEGAL ACTION OR PROCEEDING AGAINST THE RELEASED PARTIES ARISING OUT OF OR RELATED TO MY PARTICIPATION IN THE RETREAT.

11. INDEMNIFICATION
I agree to indemnify and hold harmless the Released Parties from any claims, damages, or expenses arising from:

My participation
My actions or negligence
My breach of this Agreement

12. MEDICAL AUTHORIZATION
In the event of an emergency, I authorize the Organizer to obtain medical treatment on my behalf if I am unable to do so. I agree to be financially responsible for any resulting costs.

13. MEDIA RELEASE
I grant permission for use of my image, voice, or likeness for promotional purposes.

The Organizer agrees to make reasonable efforts to respect participant privacy and will not intentionally record or capture media during highly sensitive or vulnerable moments (including but not limited to emotional processing or plant medicine experiences) without explicit consent. However, I understand that incidental or unintentional capture may occur in group settings.

14. FORCE MAJEURE
The Organizer shall not be liable for events beyond reasonable control, including natural disasters, pandemics, government actions, or travel disruptions.

15. GOVERNING LAW AND JURISDICTION
This Agreement shall be governed by the laws of the State of California and applicable laws of Costa Rica. Disputes shall be resolved in California unless otherwise required.

16. WAIVER OF JURY TRIAL
I HEREBY WAIVE ANY RIGHT TO A TRIAL BY JURY.

17. CLASS ACTION WAIVER
I AGREE THAT ANY CLAIM SHALL BE BROUGHT ONLY IN MY INDIVIDUAL CAPACITY AND NOT AS PART OF A CLASS ACTION.

18. SEVERABILITY
If any provision is found unenforceable, the remainder shall remain in effect.

19. ACKNOWLEDGMENT AND SIGNATURE
I ACKNOWLEDGE THAT I HAVE READ THIS AGREEMENT CAREFULLY, FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.

I SIGN THIS AGREEMENT FREELY AND VOLUNTARILY, WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY KIND.

Signature*

Date*

Date

Agreement to Terms*

I have read, understand, and agree to the Retreat Participant Agreement, including the Release of Liability and Covenant Not to Sue.

Liability Waiver Acknowledgment*

I understand that I am waiving significant legal rights, including the right to sue, and I agree to do so voluntarily.

Initials*

High-Risk Activity Acknowledgment*

I understand that certain activities involve physical, emotional, and altered-state experiences, and I voluntarily choose to participate and assume all associated risks.

HEALTH DISCLOSURE, SCREENING, AND INFORMED CONSENT

1. ACKNOWLEDGMENT

I understand that this retreat may involve physically, emotionally, and psychologically intense activities, including breathwork, movement practices, and optional plant medicine experiences.

I acknowledge that my honest and complete disclosure is essential for my safety and the safety of others.

2. GENERAL HEALTH CONFIRMATION*

I confirm that I am in good physical and mental health to participate in this retreat.

3. MEDICAL CONDITIONS: Please list any current or past medical conditions, injuries, or health concerns we should be aware of (or write "None"):*

4. MENTAL HEALTH HISTORY: Please disclose any history of mental health conditions (including anxiety, depression, PTSD, bipolar disorder, psychosis, or other conditions), or write "None":*

5. MEDICATIONS: Please list all medications, supplements, or substances you are currently taking (or write "None"):*

6. HIGH-RISK CONDITIONS: Please indicate if you currently have, or have a history of, any of the following:*

Allergies and Special Medical Needs (write n/a if there are none):*

7. CONTRAINDICATION ACKNOWLEDGMENT:*

I understand that certain conditions may make participation unsafe, and I agree to consult with the Organizer if I am unsure about my eligibility.

8. PLANT MEDICINE:*

I understand that participation in plant medicine ceremonies may not be appropriate for individuals with certain medical or psychological conditions, and I agree to disclose all relevant information honestly.

9. RESPONSIBILITY:*

I take full responsibility for my health, well-being, and participation, and I understand that failure to disclose relevant information may increase my risk of harm.

10. ORGANIZER DISCRETION: The Organizer reserves the right to deny or limit participation in any activity, including plant medicine ceremonies, based on disclosed or undisclosed health conditions if deemed necessary for safety.*

I understand and agree.

Emergency Contact Name: *

First NameLast Name

Emergency Contact Phone Number: *

Please enter a valid phone number.Format: (000) 000-0000.

11. DISCLOSURE:*

I confirm that I have fully disclosed all relevant medical and psychological conditions and medications, and I take full responsibility for my participation.

12. FINAL HEALTH ACKNOWLEDGMENT:*

I confirm that all information provided is accurate and complete to the best of my knowledge, and I agree to update the Organizer if anything changes prior to the retreat.

I certify that the information I have provided in this Health Disclosure section is true, accurate, and complete to the best of my knowledge.I understand that withholding or providing inaccurate information may increase my risk of harm and may result in my removal from the retreat without refund.*

Full Legal Name of Signer*

First NameLast Name

Date*

Date

FINAL REVIEW*

I confirm that I have read and understood all forms, including the Retreat Participant Agreement, Release of Liability, Assumption of Risk, and Health Disclosure. I consent to participate fully and assume personal responsibility for all risks as stated.

Signature*

JOURNEY TO YOUR SACRED HEART COSTA RICA RETREAT - 2026