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Sacred Medicine Ceremony Booking Form
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Indicates required field
Name
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First
Last
Age
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Email
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Your Cell Number
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Cell number for closest kin
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If you are not South African please share which country you are from.
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Which ceremony are you booking for?
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Four Medicine Mountain Ceremony
Do you have an past experiences with plant medicines.
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No, this is my first time.
1-3 previous experiences.
4-10 previous experiences.
10 or more.
Which plant medicines have you experienced? Please indicate if you had any challenges or difficulties with any of them.
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Are you taking any kind of medication? If yes, please explain which ones and what is it for.
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Are there any mental or physical conditions or concerns that we need to be aware of?
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What is your intention for participating in this ceremony?
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By clicking the submit button on the bottom you agree to the following terms :
1. I understand that shamanic work may include the use of traditional healing plants. I agree that I always have a choice whether or not to participate, and I agree to take full responsibility for the choices I make involving this work, both during and after the event. To the best of my knowledge, I am in good physical condition and I am not aware of any physical, physiological, or psychological infirmity which would place me at risk to participate in any way within the ceremony activities.
2. I take full responsibility for my own belongings and safe transportation to and from this event. I agree that while I have the space to authentically express myself I agree to keep to the agreements and hold the container set by the facilitators.
3. I understand that the facilitators reserve the right to deny my participation if they deem that it would be unsafe for me, or for others, or for any other important reason. I agree to listen and follow all the instructions given by the facilitators.
4. I take full responsibility for any damage that I may cause to any facility that is used for the event.
5. I understand that the facilitators reserve the right to cancel the event for any reason and that I will be fully reimbursed or given the opportunity to rebook for a later date.
5. I hereby RELEASE, WAIVE, DISCHARGE AND COMMIT NOT TO SUE the facilitator , organizers and/or participants for any and all liabilities, claims, demands arising from or related to the event. I agree to participate with the purest intention of heart, promoting the health and well-being of all participants.
6. In submitting this form I acknowledge and represent that I have read and understand the above and sign voluntarily; I excuse this release for full, adequate and complete release of liability.
Submit
Home
Sound Healing
Sound & Breath Odyssey
Plant Medicine
San Pedro Mountain Ceremony
Blue Hippo Vision Quest
Fynbos Vision Quest (CT)
Ayahuasca (Private Ceremony)
San Pedro (Private Journey)
Micro Dosing
Private Coaching
Songs
BLOG & ARTICLES
Store
Shamanic Instruments