Participant Waiver & Release Agreement

Declaration: By making a reservation for one of our events/retreats/ceremonies, I declare that:

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• I am participating in this ceremony out of my own free will.

• I have taken the responsibility to inform myself well about the effects and effects that the use of magic truffles can have on me and I am sure that my health allows me to participate safely. More specifically:

  • I do not take any medication that is incompatible with magic truffles, specifically I do not use any anti-depressive or anti-psychotic medication. I am aware that it is up to me to inform myself properly about the possible consequences that participation may have on my personal health. If I am taking medication, it is my own responsibility to check with a medical specialist whether I can safely participate in this event/retreat/ceremony.

  • I am in a physical, emotional, and mental condition that is compatible with using magic truffles; specifically, I do not have any suicidal tendencies. I am aware that it is up to me to inform myself properly about the possible consequences that participation may have on my personal health. If I am under any kind of mental treatment or if I feel mentally unstable , it is my own responsibility to check with a medical specialist whether I can safely participate in this event/retreat/ceremony.

• I am at least eighteen (18) years old.

• I acknowledge also that if I participate in the other activities/workshops offered around the truffle ceremony(s)/retreats, such as yoga, breathwork, meditation, etc, this is on my own responsibility as well. I have informed myself of the possible risks that such activities may entail and agree to participate in the truffle ceremony and any other activities/workshops at my own risk. I reserve the right not to participate in such an activity/ceremony at any time.

• I am not under the influence of narcotics or alcohol when participating. I abstained from alcohol and/or drugs for at least 5 days.

• I understand that this ceremony is not offered as an alternative to any kind of medical treatment.

• I will follow all guidelines provided regarding this ceremony, before, during, and after the ceremony provided by the organizers and/or facilitators.

• I understand that this ceremony is organized by ‘Stichting Earth Awareness’.

• I acknowledge that participating in this magic truffle ceremony is my own responsibility.

 

Emergency Contact Information:

Emergency Contact Name: _____________________________________ 

Emergency Contact Phone Number: _____________________________

 

Medical Information Disclosure:

I declare that I have filled in the intake form truthfully and have not withheld any important (medical) information. If, after completing the intake form, something has changed in my personal (medical) situation, I have informed the organization by email.

 

Consent to Medical Treatment:

In case of an emergency, I consent to receive necessary medical treatment and understand that I am responsible for any costs associated with such treatment.

 

Photography and Media Release:

I understand that photos or videos may be taken during the event/retreat for promotional purposes. During the truffle ceremony no photo’s or videos are taken.

☐ I consent                                     ☐ I do not consent                                  

to my likeness being used in promotional materials.

 

Confidentiality Agreement:

I agree to maintain the confidentiality of all participants and will not disclose any personal information shared during the event/retreat/ceremony.

 

Acknowledgment of Risks:

I acknowledge that participating in the (magic truffle) retreat/ceremony involves risks, including but not limited to psychological distress, physical discomfort, and other unforeseen risks. I voluntarily assume all such risks.

 

Waiver and Release:

In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my heirs, next of kin, and assigns as follows:

 

• A) I waive, release, and discharge from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me ‘Stichting Earth Awareness’ and/or their directors, employees, volunteers, and representatives, the activity or event holders, activity or event volunteers, owners of the location of the venue.

• B) I indemnify, hold harmless, and promise not to sue the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise.

• I acknowledge that ‘Stichting Earth Awareness’ and their directors, volunteers, representatives, owners of the venue location, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity on behalf of ‘Stichting Earth Awareness’.

 

Severability Clause:

If any part of this waiver is found to be invalid or unenforceable, the remaining provisions will continue to be valid and enforceable.

 

Jurisdiction and Governing Law:

This waiver shall be governed by the laws of the Netherlands, and any legal disputes will be resolved in the courts of the Netherlands.

 

Acknowledgment:

I have fully understood everything that has been written in this document and all documentation that I have received before.

 

Participant’s Signature: ______________________________ 

Date: _____________

Participant’s Name: ________________________________________