Kambo Waiver and Contraindication Agreement
Contraindication and Substance Guidelines Understanding and Agreement
Things to Avoid Before Kambo. Please read carefully.
Mixing Kambo with any of the following can be dangerous:
By checking the Box, you confirm that you understand the contraindications and acknowledge the risks associated with neglecting these instructions.
Kambo Contraindication
Kambo, when administered by a trained practitioner, and when participants have disclosed all underlying health conditions, does not typically have unintended adverse effects.
You should absolutely not participate in Kambo treatment if any of the following apply to you:
By checking the Box, you confirm that you understand the contraindications and acknowledge the risks associated with neglecting these instructions.
Substance Guidelines List
Review the list of substances that should be avoided before and after taking Kambo.
Substance abstinence periods
By checkin the Box next to each substance, you confirm that you understand the time period to abstain from the substance and acknowledge the risks associated with neglecting these guidelines.
By checkin the Box next to each substance, you confirm that you understand the time period to abstain from the substance and acknowledge the risks associated with neglecting these guidelines.
Specific Legal Additions
Assumption of Risk
I understand and acknowledge that the services offered by Vitaliy Sholoshnko, including Kambo ceremonies, may involve inherently hazardous activities that may result in physical injury, emotional distress, or, in extreme cases, death. By voluntarily participating in this activity, I knowingly assume the risks associated with these services, including, but not limited to, adverse physical reactions, unforeseen medical complications, allergic reactions, and any negligence on the part of Vitaliy Sholoshenko. I further affirm that I am voluntarily participating with full knowledge of the risks involved and agree to accept any and all risks of injury, death, or property damage.
Waiver of Liability for Negligence
To the maximum extent permitted under Florida law, I hereby waive, release, and forever discharge Vitaliy Sholoshenko "Released Parties", from any and all claims, causes of action, damages, demands, or liabilities of any nature, including but not limited to those arising from the ordinary negligence of the Released Parties.
This waiver includes, but is not limited to, claims for any physical or psychological injury, wrongful death, property damage, or any other harm or damages arising from my participation in a Kambo ceremony.
Hold Harmless and Indemnification
I agree to indemnify, defend, and hold harmless Vitaliy Sholoshenko from and against any and all claims, losses, damages, liabilities, costs, and expenses, including reasonable attorney's fees, that arise out of or relate to my participation in the Kambo ceremony or any breach of this Agreement. This indemnification shall apply even if the claims, damages, liabilities, or expenses are caused in whole or in part by the negligent acts or omissions of the Vitaliy Sholoshenko to the fullest extent permissible under Florida law.
Emergency Medical Treatment
Acknowledgment of Understanding
I have carefully read this Waiver and Release and fully understand its terms. I am aware that this Agreement releases the Vitaliy Sholoshenko from liability for injury, death, and property damage caused by ordinary negligence, and I sign it voluntarily of my own free will.
Florida Law Governing Provisions
This Agreement shall be governed by and construed in accordance with the laws of the State ofFlorida, without regard to its conflict of laws principles. Any legal action or proceeding arising under this Agreement shall be brought exclusively in the state or federal courts located in Miami, Florida. The parties irrevocably consent to the jurisdiction of such courts.
Severability
No Unlawful Provision
I acknowledge and agree that nothing in this Agreement shall be construed as waiving any right that cannot be lawfully waived under Florida law, including but not limited to, gross negligence, willful misconduct, or any other claims that cannot be waived as a matter of public policy.
Signature and Consent
By signing below, I affirm that I have read, understood, and agreed to the above terms and conditions. I understand that I am waiving certain legal rights by signing this document, including the right to sue for damages resulting from ordinary negligence.
Participant's Information
Emergency Contact
Electronic Signature Consent