Retreat Registration and Ceremony Agreement
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What is your full legal name? *
What is your email address? *
Are you a member of the church? *
What are your intentions for this retreat? Why are you attending? *
What experience do you have with psychedelic medicines?   *
Select the option for which you which you wish to register. *
What accommodations are you requesting? *
Are you currently taking any prescription medications or supplements? Please list and include the dosage. *
Do you suffer from any mental or physical illnesses? Please list the conditions and how long they have been present. *
Do you have any allergies including food allergies? Please list. *
Do you have any dietary restrictions or requests? *
I have read the recommendations for dieta and I am committed to doing my best to properly prepare for my communion with the medicine. *
How will you be sending your donation? Please note that your spot is not secured until you send your donation or make other arrangements. All donations are nonrefundable. 

Ancient Awakenings Temple of the Healing Arts (AATHA) ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

I hereby assume all of the risks of participating in any/all activities associated with AATHA, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released from dangerous activities or defective equipment or property owned, maintained, or controlled by them, consuming of the Sacrament (which contains Psilocybin) and other plant medicines because of their possible liability without fault. I certify that I am physically fit, have sufficiently prepared or trained for participation in this ceremonial ritual, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems or on any medications which preclude my participation in this activity. I acknowledge that this Accident Waiver and Release of Liability Form will be used by AATHA, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, 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 death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: Ancient Awakenings Temple of the Healing Arts and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers;

(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.

I acknowledge that Ancient Awakenings Temple of the Healing Arts and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, consuming the sacrament and other plant medicines, lack of hydration, excessive hydration and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants but are also present for volunteers.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I understand that certain medications can interact with our Sacrament. I have contacted my prescribing physician and confirmed that it is safe for me to sit with the Sacrament. I understand that mixing these medications can result in death.


I, the undersigned, accept the conditions of participating in ceremony held By Ancient Awakenings Temple of the Healing Arts and their team, and I declare that I am choosing to participate of my own free will. I have not been coerced into participating in sessions by the organizers or by any other person; the decision to participate is mine alone and is based on my own personal assessment of the effects, the exclusion criteria, the potential risks and benefits, the focus of the session and the commitment of the people running it.

Once the session has started, I commit to not leaving the space without the consent of the person running the session, and I commit to following the instructions always, from the preparatory stage through to integration.

Participants will surrender their keys and cell phones at the beginning of ceremony. These will be returned the morning after ceremony. Participants will stay in the ceremony area until the torches are lit.  I understand and agree that I can be excluded from participation in a session at the discretion of the facilitator. 

Typing my name below will serve as my signature stating agreement to everything noted above. (Participants may also be asked to sign a physical wavier when they arrive in the ceremony space.)

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