I understand that I am voluntarily participating in the Heart Protocol meditation conducted by Samuel Lee under the Eternal Life Tribe Church and associated staff (hereafter referred to as "Facilitators").
Welcome to the Heart Protocol Meditation, a sacred sacrament offered by the Eternal Life Tribe Church. We honor your decision to join us in this divine practice. Please carefully review the following information to ensure a safe and spiritually fulfilling experience.
1. Nature of the Meditation
I understand that the Heart Protocol Meditation is a voluntary sacred practice involving plant-based and Western psychedelic formulations. The session includes breathwork, sound healing, and other complementary healing modalities designed to support personal and spiritual growth within the framework of Eternal Life Tribe Church’s teachings.
2. Acknowledgment of Risks and Side Effects
I recognize that participation in this meditation may involve certain risks, including but not limited to:
Physical Side Effects: Increased heart rate, elevated blood pressure, nausea, chills, sweating, blurred vision, muscle cramping, and teeth clenching.
Psychological Side Effects: Anxiety, agitation, paranoia, hallucinations, and altered perceptions of time and reality.
After Effects: Feelings of depression, irritability, fatigue, difficulty concentrating, decreased appetite, and disrupted sleep patterns.
Additional Risks: Potential neurotoxicity, memory impairment, and serotonin syndrome.
I acknowledge these potential risks and accept full responsibility for my participation.
3. Health and Medical Disclosure
I have fully disclosed my relevant medical history, including any physical or mental health conditions, allergies, and current medications, to the facilitator. I understand the importance of this information for ensuring a safe meditation experience.
4. Voluntary Participation and Personal Responsibility
I affirm that my participation is entirely voluntary and that I have the autonomy to decide whether or not to engage in the Heart Protocol Meditation. I retain the right to withdraw from the session at any time. I accept full responsibility for my choices related to my participation.
5. No Guarantees of Specific Outcomes
I understand that the Heart Protocol Meditation does not guarantee specific results or outcomes. Individual experiences may vary based on personal circumstances and engagement.
6. Confidentiality
I commit to respecting the privacy and confidentiality of all participants. I understand how my personal information and any disclosures made during the session will be handled with discretion and care.
7. Waiver of Liability
I hereby release, waive, and discharge the Eternal Life Tribe Church, its facilitators, staff members, volunteers, and property owners from any and all liability, claims, demands, actions, or causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me during my participation in the Heart Protocol Meditation, whether caused by negligence or otherwise. This waiver applies to all claims for damages or injuries caused by any act or omission related to my participation in the session.
8. Emergency Procedures
I have been informed of the emergency procedures in place and understand the steps to take should an urgent situation arise during the meditation. I agree to follow the facilitator’s instructions in the event of an emergency.
9. Age and Consent
I confirm that I am at least 18 years of age and possess the legal capacity to provide informed consent for my participation in the Heart Protocol Meditation.
10. Substance Policy
I agree to adhere to the substance-free policy during the Heart Protocol Meditation. I confirm that I have not consumed alcohol, recreational drugs, or other prohibited substances prior to and during the session, except for the medicine provided as part of the Heart Protocol.
11. Cancellation and Refund Policy
60+ days before retreat: Full refund
30-59 days before retreat: 50% credit toward future retreat
Less than 30 days before retreat: No refund or credit
I acknowledge that the terms of cancellation and the refund policy. I have reviewed and understand these terms prior to registering for the Heart Protocol Meditation.
12. Code of Conduct
I agree to follow the established code of conduct to maintain a respectful and safe environment for all participants. I understand that adherence to these guidelines is essential for the collective well-being of the group.
13. No Doctor - Patient Relationship
I understand that this retreat is for spiritual wellness purposes only and does not constitute medical care. I acknowledge that the facilitators are not acting as healthcare providers and no doctor-patient relationship is established.
Participant’s Acknowledgment
By agreeing, I confirm that I have read, understood, and agree to the terms outlined in this Waiver of Liability and Informed Consent form. I acknowledge that I have had the opportunity to ask questions and have received satisfactory answers regarding my participation in the Heart Protocol Meditation. I affirm that my participation is a sacred sacrament within the Eternal Life Tribe Church and that I am entering into this practice with full awareness and understanding.