IXCA LIFE Sanctuary Sacred Ceremonial Preparation and General Liability Waiver
Safety is our #1 priority. To date there have been zero accidents or fatalities. Our intention is to support your overall physical, spiritual, energetic and emotional wellbeing with the highest degree of integrity and safety while attending at the retreat location. We do not assume responsibility when off-site, travel to and from the location or at any time or place outside the designated retreat address. 

Safety, Cleanliness and Conscious Contributions 
During retreats this is a team effort to facilitate fluidity, organization and cleanliness of our retreat location and personal spaces. We utilize the support of location staff, native volunteers, native healers and the like. It is customary to leave cash tips for the exceptional work they do to support the overall and individual successes of our experience together. Tips are not required. However, please consciously consider your contribution to uplift another should you feel it appropriate to do so. 

YOU MUST RETURN THIS ATTACHMENT STATING YOU HAVE FULLY READ IT AND
UNDERSTAND ALL STATED REQUIREMENTS FOR PARTICIPATION.

DECLARATION OF REGISTRATION
By registering for a program, you are declaring that you are in physical and mental condition
appropriate to the activities described in the workshop program. You  agree to participate at
your own risk, and you assume liability for any accident or injury. We will provide the
most secure environment to ensure your welfare to the best of our abilities, at all times.

Retreat and Ceremonial Locations can include United States, Mexico and Peru
Exact address: Provided at time of registration
Dates: Provided at time of registration 

Retreat Activities:
Yoga
Music 
Dance 
Ayahuasca (VINE ONLY)
Tobacco Ceremony 
San Pedro Ceremony 
Cacao Ceremony 
Bufo Ceremony 
Hapé Ceremony 
Xanga Ceremony 
Psilocybin integrative medicine 
XAMANIC Practices 
Religious Medicinal Rites and Practices 
Hypnosis 
QHHT Therapy 
Curanderismo 
Ancestral Medicine Cleanses
Plant Bathes
Sound and Drum Therapy 
Breath Work 
Prayer Circles 
Group Transportation 

-YOU ARE PERSONALLY RESPONSIBLE FOR FULL DISCLOSURE OF ALL DRUG AND HERBAL
SUPPLEMENT USE. 

-YOU ARE FULLY RESPONSIBLE FOR SEEKING MEDICAL ADVICE AND/OR MEDICAL RELEASES TO PARTICIPATE IN THIS RETREAT. THIS IS YOUR FULL RESPONSIBILITY.

-YOU ARE PERSONALLY RESPONSIBLE FOR YOUR PARTICIPATION IN ANY OF THE SACRED XAMANIC CEREMONIES AND RELEASE QHHT BODY TALK, IXCA Life Sanctuary, QINTY PERU AND ALL THERAPISTS, FACILITATORS  AND SUPPORT STAFF FROM ANY PERSONAL OR GROUP LIABILITY OF POTENTIALLY ADVERSE EFFECTS YOU MAY OR MAY NOT EXPERIENCE DURING OR AFTER ANY SACRED XAMANIC CEREMONY, RITUAL OR HEALING CIRCLE.

-BY SUBMISSION OF YOUR PAYMENT AND OR DONATION YOU ACCEPT THESE TERMS AND CONDITIONS FULLY.


About XAMANIC Plant Practices

The old XAMANIC traditions and hallucinogenic plants…

What you must know prior to working with shamanic medicine:

In the old shamanic traditions the shaman often worked with plants that were hallucinogenic or psychotropic to receive wisdom and guidance from the plant and to access altered states of consciousness.  

In order to be able to work with the spirit of the plant, the physical plant material was smoked, chewed, brewed or ingested in some way.

It was well understood that only those who had undergone highly specialised training were able to safely work with these plants. 

How ancient shamans worked with hallucinogenic plants…

What is not commonly known is that when working with hallucinogenic plants, there is a range of mild to severe possible side effects that can occur on both the physical and metaphysical levels.

These side effects can range from vomiting and diarrhea to 'blown' or damaged chakras, psychosis and even death, which is not as uncommon as most people think. 

These negative side effects may occur for days, months and years after the plant has been ingested. In some extreme cases, the human soul can suffer very undesirable consequences.

For this reason, in ancient times, the shaman went through a series of special steps that could span a few days or sometimes weeks to prepare themselves for ingesting the plant material.

Often this was followed by a special detoxification process to help the shaman ‘return’ safely to the physical realm and to prevent severe side effects that could result from toxic build up and eventually take a toll on the shaman’s physical organism. 

 



———————

Please read the full list of contraindications whether you are on medications or not, you must review the list below. 

Our priority is your safety and well being, and to guide you to personal healing and growth.
You will be asked to fill out a medical questionnaire. Please be as forthcoming as possible when answering the questions. If any potential medical contraindications are present, we will inquire further to ensure your safety.

General Medical Precautions
Working with any form of XAMANIC healing can carry physical, emotional and energetic shifts. It is necessary that you disclose any of the following:

-heart, liver, kidney, pancreatic, or other serious medical condition, and/or use of any medication
at the time of booking. 
-diabetes or a hepatic conditions must provide more information about the condition
-heart condition or chronic high blood pressure 
 -tuberculosis must not take ayahuasca
 -pregnant
-history of psychological conditions
-known mental health conditions 


Contraindications
From an Amazonian plant healer’s perspective, when a patient or apprentice is working with 
medicinal plants, it is preferable to not take any other substances/ medicines. This may cause
cutipado or, in other words, interfere with the plant’s energy and provoke unwanted reactions.

Certain drugs and medications have been found to not be compatible with xamanic healing. It is
essential to stop taking the substances listed in this document and give your system sufficient
time to remove them from the body before you begin a program.

You should not stop taking prescribed medications without consulting your doctor.

Contraindications: Herbal Medicine and Supplements
Please notify us of any herbal or natural medicines you are taking, as well as any supplements.

• St Johns Wort
• Kava
• Kratom
• Ephedra
• Ginseng
• Yohimbe
• Sinicuichi
• Rhodiola Rosea
• Kanna
• Boswellia
• Nutmeg
• Scotch Broom
• Licorice Root
• Cannabis

Contraindications: Drugs and Medications:

Any medication that contains MAO inhibitors (MAO-Is) are known to cause dangerous side
effects when taken in conjunction with ayahuasca and should be suspended. Any medication
that has an effect on the serotonin system, including Selective Serotonin Reuptake Inhibitors
(SSRIs), can induce serotonin syndrome, with potentially fatal results when combined with
ayahuasca. We advise that SSRI medications be suspended six weeks prior to a workshop to
allow the system to clear in time. Some of these drugs may cause side effects when you stop
taking them so you should allow plenty of time for these to subside and always consult your
physician before changing your medical schedule.

PLEASE NOTE: The following list is by no means complete. We will review any medications or
supplements you are taking before we confirm your booking.

• SSRI’s (any selective serotonin reuptake inhibitors)
• Asthma inhalers
• Antihypertensives (high blood pressure medicine)
• Appetite suppressants (diet pills)
• Medications for asthma, bronchitis, or other breathing problems
• Antihistamines, medicines for colds, sinus problems, hay fever, or allergies (any
cold, cough, or flu preparations, and any drug with DM, DX or -tuss in its
name.)
• CNS (central nervous system) depressants
• Antipsychotics
• Barbiturates
• Tranquilizers
• Sympathomimetic amines (including pseudo ephedrine and ephedrine)
• Alcohol
• Amphetamines
• Opiates
• Mescaline (any phenethylamine)
• Barbiturates
Specific Contraindicated Drugs:
• Actifed
• Adderall
• Alaproclate
• Albuterol (Proventil, Ventolin)
• Amantadine hydrochloride (Symmetrel)
• Amineptine
• Amitriptaline
• Amoxapine (Asendin)
• Asarone/Calamus
• Atomoxedine
• Befloxetone
• Benadryl
• Benylin
• Benzedrine
• Benzphetamine (Didrex)
• Bicifadine
• Brasofensine
• Brofaromine
• Bromarest-DM or -DX• Bupropion (Wellbutrin)
• Buspirone (BuSpar)
• Butriptyline
• Carbamazepine (Tegretol, Epitol)
• Chlorpheniramine
• Chlor Trimeton
• Cimoxetone
• Citalopram
• Clomipramine (Anafranil)
• Cocaine
• Codeine
• Compoz
• Cyclobenzaprine (Flexeril)
• Cyclizine (Marezine)
• Dapoxotine
• Desipramine (Pertofrane, Norpramin)
• Desvenlafaxine
• Dextroamphetamine (Dexedrine)
• Dextromethorphan (DXM)
• Dibenzepin
• Dienolide kavapyrone desmethoxyyangonin
• Diethylpropion
• Dimetane-DX
• Disopyramide (Norpace)
• Disulfiram (Antabuse)
• Dopamine (Intropin)
• Dosulepin
• Doxepin (Sinequan)
• Dristan Cold & Flu
• Duloxetine
• Emsam
• Ephedrine
• Epinephrine (Adrenalin)
• Escitalopram
• Femoxitine
• Fenfluramine (Pondimin)
• Flavoxate Hydrochloride (Urispas)
• Fluoxetine (Prozac)
• Fluvoxamine
• Furazolidone (Furoxone)
• Guanethedine• Guanadrel (Hylorel)
• Guanethidine (Ismelin)
• Hydralazine (Apresoline)
• 5 Hydroxytryptophan
• Imipramine (Tofranil)
• Iprindole
• Iproniazid (Marsilid, Iprozid, Ipronid, Rivivol, Propilniazida)
• Iproclozide
• Isocarboxazid (Marplan)
• Isoniazid (Laniazid, Nydrazid)
• Isoniazid rifampin (Rifamate, Rimactane)
• Isoproterenol (Isuprel)
• L dopa (Sinemet)
• Levodopa (Dopar, Larodopa
• Linezolid (Zyvox, Zyvoxid)
• Lithium (Eskalith)
• Lofepramine
• Loratadine (Claritin)
• Macromerine
• Maprotiline (Ludiomil)
• MDA
• MDEA
• MDMA (Ecstasy)
• Medifoxamine
• Melitracen
• Meperidine (Demerol)
• Metaproterenol (Alupent, Metaprel)
• Metaraminol (Aramine)
• Methamphetamine (Desoxyn)
• Methyldopa (Aidomet)
• Methylphenidate (Ritalin)
• Mianserin
• Milnacipran
• Minaprine
• Mirtazapine (Remeron)
• Moclobemide
• Montelukast (Singulair)
• Nefazodone
• Nialamide
• Nisoxetine
• Nomifensine• Norepinephrine (Levophed)
• Nortriptyline (Aventyl)
• Oxybutynin chloride (Ditropan)
• Oxymetazoline (Afrin)
• Orphenadrine (Norflex)
• Pargyline (Eutonyl)
• Parnate
• Paroxetine (Paxil)
• Pemoline (Cylert)
• Percocet
• Pethedine (Demerol)
• Phendimetrazine (Plegiline)
• Phenelanine
• Phenergen
• Phenmetrazine
• Phentermine
• Phenylephrine (Dimetane, Dristan decongestant, Neo Synephrine)
• Phenylpropanolamine (in many cold medicines)
• Phenelzine (Nardil)
• PMA
• Procarbazine (Matulane)
• Procainamide (Pronestyl)
• Protriptyline (Vivactil)
• Pseudoephedrine
• Oxymetazoline (Afrin)
• Quinidine (Quinidex)
• Rasagiline (Azilect)
• Reboxetine
• Reserpine (Serpasil)
• Risperidone
• Robitussin
• Salbutemol
• Salmeterol
• Selegiline (Eldepryl)
• Sertraline (Zoloft)
• Sibutramine
• Sumatriptan (Imitrex)
• Terfenadine (Seldane D)
• Tegretol
• Temaril
• Tesofensine• Theophylline (Theo Dur)
• Tianeptine
• Toloxatone
• Tramidol
• Tranylcypromine (Parnate)
• Trazodone
• Tricyclic antidepressants (Amitriptyline, Elavil)
• Trimipramine (Surmontil)
• Triptans
• Tryptophan
• Tyrosine
• Vanoxerine
• Venlafaxine (Effexor)
• Viloxezine
• Vicks Formula 44-D
• Yohimbine
• Zimelidine
• Ziprasidone (Geodon)
* SSRI’s, like Kanna (any selective serotonin reuptake inhibitor)
* Alcohol
* Antipsychotics
* Appetite suppressants (diet pills)
* CNS (central nervous system) depressants
* Amphetamines (including meth and dex, variants)
* Antihypertensives (high blood pressure medicine)
* Medicine for asthma, bronchitis, or other breathing problems
* Antihistamines, medicines for colds, sinus problems, hay fever, or allergies (Actifed DM,
Benadryl, Benylin, Chlor-Trimeton, Compoz, etc.)
Specific drugs and herbs to be avoided:
* Actifed
* Amantadine hydrochloride (Symmetrel)
* Amoxapine (Asendin)
* Benadryl
* Benylin
* Bupropion (Wellbutrin)
* Buspirone (BuSpar)
* Carbamazepine (Tegretol, Epitol)
* Chlor-Trimeton
* Clomipramine (Anafranil)
* Cocaine
* Cyclobenzaprine (Flexeril)
* Cyclizine (Marezine)
* Desipramine (Pertofrane)
* Dextromethorphan (DXM)
* Disopyramide (Norpace)
* Doxepin (Sinequan)
* Ephedra
* Ephedrine
* Flavoxate Hydrochloride (Urispas)
* Fluoxetine (Prozac)
* Ginseng
* Imipramine (Tofranil)* Isocarboxazid (Marplan)
* Kava
* Levodopa (Dopar, Larodopa)
* Loratadine (Claritin)
* Maprotiline (Ludiomil)
* Meperidine (Demerol)
* Methylphenidate (Ritalin)
* Nortriptyline (Aventyl)
* Oxybutynin chloride (Ditropan)
* Orphenadrine (Norflex)
* Parnate
* Paroxetine (Paxil)
* Phenergen
* Phenelzine (Nardil)
* Procainamide (Pronestyl)
* Protriptyline (Vivactil)
* Pseudoephedrine
* Quinidine (Quinidex)
* Salbutemol
* Salmeterol
* Selegiline (Eldepryl)
* Sertraline (Zoloft)
* Sinicuichi
* St John's Wort
* Tegretol
* Temaril
* Tranylcypromine (Parnate)
* Tricyclic antidepressants (Amitriptyline, Elavil)
* Trimipramine (Surmontil)
* Yohimbine

• Using stimulants with MAO-Is is particularly dangerous and can be potentially fatal.
Using cocaine, amphetamines or MDMA (Ecstasy) with MAO-Is may cause a severe increase in
blood pressure, increasing the chances for stroke and cerebral hemorrhage and making it
possible to overdose on a relatively small amount of cocaine. (A fatality has been recorded
involving combining Peganum harmala and cocaine. Fatalities resulting from combining
amphetamines with pharmaceutical MAO-Is are recorded in medical literature.)
• Using other serotonin agonists or precursors with an MAO-I can lead to serotonin syndrome.
The main symptom of serotonin symptom may be a severe and long- lasting headache (the
same symptom as MAO-I tryptamine interaction) and/or fever (as high as 40 °C / 104 °F or
more) Other symptoms of serotonin syndrome may include rapid heartbeat, shivering, sweating,
dilated pupils, intermittent tremor or twitching, overactive or over-responsive reflexes,
hyperactive bowel sounds, high blood pressure. Severe serotonin syndrome may lead to shock,
agitated delirium, muscular rigidity and high muscular tension. renal failure, seizures, and can
be life- threatening.
• Using Tricyclic antidepressants within two weeks of taking MAO-Is may cause serious side
effects including sudden fever, extremely high blood pressure, convulsions, and death.
• Using Fluoxetine (Prozac) within five weeks of taking MAO-Is may cause high fever, rigidity,
high blood pressure, mental changes, confusion and hypomania.
• Using Benzedrine, Benzphetamine, Desipramine, Desoxyn, Dexedrine, Dopamine, Ephedrine
(contained in Marax, Quadrinal, and other asthma drugs), Epinephrine,
Guanadrel, Guanethidine, Hydralazine, Isoproterenol, L-dopa, Metaraminol, Methyldopa,
Mirtazamine, Norepinephrine Oxymetazoline, Phendimetrazine, Phentermine, Phenylephrine,
Phenylpropanolamine, Pseudoephedrine, Ritalin, or Venlafaxine with MAO-Is may cause a
hypertensive crisis (severe spike in blood pressure).• Using Adderall with MAO-Is can result in high body temperature, seizure, and in some cases
coma.
• Using Bupropion (Wellbutrin) within two weeks of taking MAO-Is may cause serious side
effects such as seizures.
• Using Buspirone (Buspar) with MAO-Is may cause high blood pressure and increased sedative
effects.
• Using Carbamazepine (Tegretol) with MAO-Is may result in fever and may increase seizures,
especially in epileptics.
• Using Clomipramine with MAO-Is may cause high fever (hyperpyrexic crisis) and seizures.
• Using CNS depressants with MAO-Is may increase the depressant effects.
• Using Desipramine (Norpramin, Pertofrane) with MAO-Is may result in hypertensive
crisis.
• Using Dextromethorphan with MAO-Is may cause excitement, high blood pressure,
and fever, or brief episodes of psychosis.
• Using Fenfluramine with MAO-Is may result in fever (hyperpyrexic crisis).
• Using Lithium with MAO-Is may cause fever and serotonin syndrome.
• Using Meperidine (Demerol) with pharmaceutical MAO-Is has resulted in deaths from
a single dose.
• Using Metaproterenol or other beta-adrenergic bronchodilators with MAO-Is may
cause blood pressure elevation and rapid heartbeat.
• Using Mirtazapine (Remeron) with MAO-Is may result in hypertensive crisis.
• Using Nefazodone (Serzone) may result in high fever.
• Using Temaril with MAO-Is may increase chance of side effects.
• Using Terfenadine with MAO-Is may cause an increase in MAO-I blood levels.
• Using Theophylline with MAO-Is may cause rapid heartbeat and anxiety.
• Using Trazodone (Desyrel) with MAO-Is may result in high fever.
• Using Tryptophan or L-tryptophan with MAO-Is may cause disorientation, confusion,
amnesia, delirium agitation, memory impairment, hypomanic signs, shivering.
• Using Venlafaxine (Effexor) with MAO-Is may result in hypertensive crisis.
• Using Ziprasidone (Geodon) with MAO-Is may cause serotonin syndrome.
• Using alcohol with MAO-Is may cause side effects like angina (chest pain) or
headaches. The headache may mask or be mistaken for hypertensive crisis caused
by MAO-I interaction. MAO-Is can also increase the sedative effect of alcohol.
• Using opiates with MAO-Is carries a risk of respiratory depression.
• Using diuretics with MAO-Is may cause a greater drop in blood pressure than normal
and increase in MAO-I blood levels.
• Using anesthetics with MAO-Is may potentiate the anesthetic effect.
• Using sleeping pills, tranquilizers (major or minor), or barbiturates with MAO-Is may
increase the sedative effect.

Electronic Devices 
We ask you to honor the ambiance and sacredness of this experience by keeping your electronic devices during ceremonies shut off. A daily call home to family is expected. We’re fostering an entirely
different kind of connection. All phone calls must be made outside the building. Contemplation is the key.

Special Dietary Guidelines:
-Please follow the dietary recommendations 72 hours prior to Sacred Ceremonial Retreat.
-Depending on the medications or substance a full solid 6 weeks prior to Sacred Ceremonial Journey they should be stopped. 
-These recommendations are for the benefit, safety and overall wellbeing of each
participant. More in depth guidance can be given based upon individual participant needs.

WHICH FOODS AND DRINKS SHOULD BE AVOIDED IN EXCESS? 
The following foods and drinks contain high amounts of tyramine:
* Meat that is not fresh – especially liver
* Processed meats such as sausage, bologna, pepperoni, salami etc.
* Protein extracts
* Protein dietary supplements
* Aged cheese
* Any fish that is not fresh or has undergone some form of treatment (for example, smoked,
fermented, pickled or dried fish etc.)
* Yeast in any form
* Soy sauce and fermented soybean paste
* Fermented tofu
* Fermented bean curd
* Canned soup, bouillon or ant soup with protein extracts in.
* Miso soup
* Sauerkraut
* Fruit that is bruised or overripe.
* Dried fruits including, but not limited to, raisins and figs.
* Avocado and guacamole
* Any alcoholic drinks and their non-alcoholic variants (for example non-alcoholic beer)
* Dairy products that have not been refrigerated or are close to their expiration date
* Shrimp paste
* Fava beans
* Aspartame
* Large amounts of peanuts
* Large amounts of raspberries
* Large amounts of spinach
*Large amounts of chocolate
* Caffeine
HOW LONG SHOULD THESE FOODS AND DRINKS BE AVOIDED FOR?
Generally speaking, you should  avoid the excess of these substances for 72 hours hours before and after the
ceremony.

Email *
Full Name *
Birth Date *
Phone number *
Emergency Contact Person and Phone number *
Please list any listed medications or substances you are currently consuming. If there are none type “NONE” *
Please list any questionable medical conditions. If there are non type “NONE”  *
I am fully aware I am responsible for seeking medical advice for participation in this retreat should I have a concern. *
I agree to respect the sacredness and privacy of all participants and will keep my cell phone and electronic device use to a minimum. I agree I will not use my cell phone during quiet times, rituals or ceremonies. I agree my phone calls will be purposeful and kept outside of the building.  *
I agree to follow preparation guidelines, improve my overall wellbeing and honor my physical, emotional and spiritual needs as a priority for participation.  *
I have read this form in its entirety and agree with taking all necessary steps for preparation and assuming personal liability.  *
A copy of your responses will be emailed to the address you provided.
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