LEGAL AGREEMENTS
Please read the following before checking each box and typing your name below.
1. Acting on My Own Behalf — I attest that I am submitting this application for myself, all information provided is my own, and I am not applying on behalf of anyone else.
2. Health Screening & Full Disclosure — I have truthfully disclosed all conditions, supplements, and medications relevant to the service(s) I selected, and I will report any changes before my session(s). I understand my participation may be declined at the facilitator's discretion due to falsified or omitted information, undisclosed contraindications, or unsafe behavior. Any applicable refund will follow the Payment Policy.
3. Not a Medical Service — I understand these are complementary wellness and ceremonial services, not medical treatment, and the facilitator is not a licensed physician, psychologist, or mental health professional.
4. Medication Changes — I agree to consult a licensed physician before making any changes to prescribed medication, and to notify the facilitator of any changes before my session(s).
5. Assumption of Risk & General Release of Liability — By checking the box below and typing my name, I acknowledge and agree to the following as a condition of my participation in the service(s) I have selected with Esencia by GlendaLee — which may include Kambo, Bufo/5-MeO-DMT, Reiki, Meditation, and/or Access Bars®: (A) I voluntarily waive, release, and discharge Esencia by GlendaLee, Glenda Lee Nazario, assistants, property owners, and affiliates (collectively, “Releasees”) from any and all liability, including but not limited to liability for death, disability, personal injury, property damage, or any other loss arising before, during, or after my session(s), except where prohibited by applicable law. (B) I agree to indemnify and hold harmless the Releasees from any claims arising from my participation. (C) I understand that, depending on the service(s) I selected, possible effects may include nausea, vomiting/purging, burns at the application site, swelling, temporary changes in blood pressure or heart rate, an intense altered state, disorientation, or emotional release, and I voluntarily accept these risks. (D) I affirm that I am physically and mentally prepared for my session(s), have disclosed all relevant health information, and have not been advised against participation by a medical professional. (E) I consent to receive emergency medical treatment if deemed necessary during my session(s), and understand I am solely responsible for any resulting medical expenses. I certify that I have read and fully understood this waiver and agree to its terms willingly.
6. Legal Framework Acknowledgment — I understand that Kambo and Bufo/5-MeO-DMT exist within an evolving legal framework in the jurisdiction where the services are provided, and I voluntarily assume responsibility for my participation in any service involving them.
7. Pre-Session Communications & Payment Policy — I agree to read all messages sent to me before my session(s), understanding they may contain required preparation steps specific to the service(s) I selected.
I understand that my appointment is not confirmed until my intake has been reviewed and my required deposit has been received. If approved, I will receive payment instructions by email. I understand that a 50% non-refundable deposit is required to reserve my appointment, and the remaining balance must be paid before my scheduled session.
8. Confidentiality Agreement — By checking the box below, I agree that anything shared by myself or by other participants before, during, or after my session(s) — including personal stories, health information, or experiences during ceremony or session — will be kept strictly confidential. I agree not to disclose the identity or personal experiences of any other participant without their express consent. I understand that Esencia by GlendaLee likewise commits to keeping my personal and health information confidential, except where disclosure is required for my safety (such as a medical emergency) or by law.
By checking each box below and typing my name in CAPS, I confirm that I have read, understood, and agree to the corresponding section above.