The “Organiser” is Christian Adams

The “Participant” is the person named and signed at the bottom of this document.

1. The Participant agrees to take part in the retreat, including its plant ceremonies.
2. The Organiser will do their utmost to ensure the safety and comfort of the Participant within the remit of this program. The Participant, in turn, agrees to exercise caution and consideration for him or herself and for others during this retreat, including at the venue and in other environments, and indemnifies the Organiser against claims for injury, loss, damage, misadventure or inconvenience at all stages. 
3. The Organiser has recommended that the Participant, prior to entry into this Agreement, seeks and obtains health or medical advice as to the effect of plants and herbal medicines singly and in combination with any medication they are taking. The Participant avows that he or she, having done so or deemed it unnecessary, is in a physical and mental condition appropriate to the activities described in this brochure and agrees to participate at his or her own risk. The responsibility for taking accurate and timely health precautions, professional medical advice, and for acting upon this (or otherwise) is solely with the Participant.    
4. The Participant has the option of joining any, all, or none of the activities on offer during the retreat and taking any, all or none of the plants available, and should he or she wish to take them does so voluntarily, taking full responsibility for his or her actions. 
5. The Participant has been advised that Ayahuasca is a visionary plant and is clear on the meaning of this. Reference sources have been provided which may describe the Ayahuasca experience and the Participant has conducted other research where appropriate to satisfy him or herself of the effects that may be produced. The liability is with the Participant.   
6. The Participant agrees to show respect for the environment he or she is in and to act with courtesy and dignity towards other group members. Should the Participant commit any illegal act or should his or her behaviour adversely affect other people’s enjoyment of this event he or she may be asked to leave the property.  
7. The Participant agrees to stay in the Ayahuasca ceremonies until they are formally closed by the shaman.  They will not return to their sleeping area or go to any other place during the ceremony. This is for their own safety and the well-being of all participants. Should the Participant not follow this rule they may be asked to leave the property.
8. The Participant has read, understood and voluntarily signed this document and agrees that no representations, statements or inducements have been made by the Organisers for him/her to take part in this program or to sign this Agreement. By signing the Participant waives certain legal rights, including the right to sue.   

Participant’s Name: 

Judith Fuller__Date:_11/02/2019

Participant’s Signature: JMFuller

Participant’s Address: 43 Belconnen Way Weetangera ACT 2614

Participant’s Phone #: 0476 195 034 

Participant’s E-mail Address: judithmfuller@gmail.com

Emergency Contact Name: Tony Fuller (father) 

Emergency Contact Phone #: +61418 607 430