Training Registration Agreement

Medicinal Mindfulness

Psychedelic Sitters School

Training Registration Agreement 2019 v2

PLEASE NOTE: If you are flying in from a lower elevation, please drink plenty of water, electrolytes and stay hydrated!

***Important Disclaimer***

Psychedelic Sitters School is a professional training program. Acceptance into the training program is not guaranteed. All candidates will be assessed on an individual basis. Only after the registration steps below have been properly completed, will a final determination be made regarding your potential acceptance into the program. As such, do not confirm any logistical/travel arrangements (e.g., requesting time away from work, purchasing airfare, etc.) until you have been contacted by us, in writing, of your formal acceptance into the program. Medicinal Mindfulness LLC, Medicinal Mindfulness Events LLC, and/or any of their officers and/or owners will not be held liable for any such incurred costs.Tuition & Other Costs

Please review the 2019 Psychedelic Sitters School Training Information Guide for program costs and training dates.

Designated Driver or Taxi Service Required if cannabis is consumed

PLEASE NOTE: If you drive yourself to the event or do not have a designated driver, we will help you schedule a cab. You will be unable to use cannabis at the event without a pre-arranged ride from this event. Ridesharing: www.uber.com & www.lyft.com Local Taxi: www.zTrip.com (303)699-8747 - Taxi service pick ups can be scheduled prior to event. Driving to and from a residential retreat is allowed only if cannabis is not consumed on the day of travel.

Payment & Refund Policy

Half of total retreat payment is required to reserve your spot in a training retreat, with the second half of the payment due two months before the first day of class. Retreat payments are non-refundable. Before paying the first half of the retreat deposit, please confirm that the dates work on your end, and that you have all of your questions answered regarding safety and the participation agreements. Due to the support services provided and logistics required to facilitate these events, no refunds will be issued once payments are received.

Certificates of Completion and Certification

Trainees that complete the weekend training will receive certificates of completion. Level 1 Psychedelic Sitters School is a prerequisite for other trainings as well as our sitter and facilitator certification program.

REGISTRATION INFORMATION

Please review and follow the 4 easy steps to register for Level 1: Psychedelic Sitters School.

STEP 1: Read and complete the following forms and use our inquiry form to express interest, request an interview, or to ask any general questions by email:

Psychedelic-Cannabis Safety Self-Assessment
Conscious Cannabis Event Participation Agreement
Community Breathwork Participation Agreement
Medicinal Mindfulness Safe Community Policy
Training Registration Agreement (this document)

STEP 2: Once you’re ready to apply, submit $90 payment for your 30 Minute Phone Interview, Application Review, & Safety Assessment [store link] and email us at events@medicinalmindfulness.org to schedule your interview and assessment.

In the email, briefly introduce yourself, your experience and training, describe your interest in this program, and what you hope to learn/experience (250-word max). We will respond as quickly as possible to confirm a date and time for your call. Please note that this payment is non-refundable, should your application into the program be declined.

STEP 3: Interview & Assessment Phone Call (30 minutes)

STEP 4: Sit back, relax, and we’ll get back to you! We may request some additional information, or we may have everything that we need to formally respond to you in short order. Approved applicants will be notified and invoiced; once full payment has been received, the registration process is complete! You will gain access to the webinar as well as the Medicinal Mindfulness Online Community Forum to meet other retreat participants.

Training Participation Agreement

Medicinal Mindfulness is committed to making safe and skillful journeywork and guidework practices as accessible as possible. Becoming skillful in our journey, sitting and guiding techniques takes time and a lot of practice. In addition to this, because of the spiritual or transpersonal nature of our work, we are required to go through our own healing and awakening process, often in ways we didn’t know before we began. These can be big experiences for our students and members. For this reason, we have created a “stepping into” process, levels of training and competence that each have requirements and intentional commitments. We do this for safety reasons, not as a way to limit our members or students in any way.

Psychedelic Sitters School is more than an introductory experience, but in no way can a five day training adequately prepare a student for all situations that a sitter or guide will encounter. We take this work very seriously and are committed to supporting our students in reaching the highest level of training and skill that they wish to reach. This takes time. Under no circumstances can our students represent our work adequately in public settings, or the teachings without first going through a significant period of training and skill set development and experience with our program. By participating in this program, you agree to take your time with this process and to not place yourself in situations that are above your ability, training and experience. Knowing your limitations and gifts takes time. Facilitating your own groups or individual experiences without the right support can cause harm to yourself and others.

Assumption of Risk

In consideration of the services of Medicinal Mindfulness LLC & Medicinal Mindfulness Events LLC affiliates: Daniel McQueen and training assistants, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as MM), I hereby agree to release and discharge MM, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:

Emotional Risk:

I acknowledge that I understand this is a professional training, which includes self-reflection, interactive exercises, time outdoors, and professional growth. I acknowledge that I have choice about the level of my participation at all times and that, although personal material may arise for me within the context of the training, this is not therapy, and I am responsible for my own well-being. If I feel the need arises for therapy, I will take action accordingly or request the appropriate resources.
I am aware that participants are asked to hold confidentiality of personal material disclosed in the training, but this cannot be guaranteed.
I understand that a MM training is intended as a personal growth experience and should not be used as a substitute for psychotherapy or medical treatment.
I understand that a MM training could involve dramatic experiences accompanied by strong emotional and physical release as outlined in the CCE Participation Agreement.

Physical Risk:

I have read the Conscious Cannabis Experience participation agreement and the Community Breathwork participation agreement and acknowledge the inherent risks in participating.
I certify that I have adequate health insurance to cover any injury or damage I may suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.

General:

I understand that the use of cannabis is completely optional and that I agree to only use cannabis in designated areas.
I understand that the use or possession of illicit substances and alcohol before, during, after or around the training is explicitly forbidden and that I will be immediately asked to leave the training program if I bring, use or offer illicit substances to other students.
I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless MM from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of MM's equipment or facilities, including any such claims which allege negligent acts or omissions of MM
I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.
Should MM or anyone acting on its behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
In the event that I file a lawsuit against MM, I agree to do so solely in the state of Colorado, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against MM on the basis of any claim from which I have released them herein.

Psychedelic-Cannabis Safety Self-Assessment 2019 v9

I agree to read and answer the Safety Self-Assessment before my interview with a Medicinal Mindfulness facilitator. While cannabis is legal in Colorado to possess and consume in certain contexts, and is used recreationally and safely by millions of people, I understand that Conscious Cannabis Events (CCEs) are transformational experiences that are more akin to meditation retreats and other entheogenic practices. By signing this form and by attending Psychedelic Sitters School, I certify that that I am physically, mentally, emotionally and spiritually fit enough to safely participate. I also acknowledge that I can speak with a Medicinal Mindfulness facilitator about any safety concerns before attending the training.

In case of emergency, I understand that effort will be made to secure proper treatment. I hereby give permission for such treatment. My personal health and accident insurance covers any accident or illness that I may incur during this experience and I will personally guarantee any cost or other liability incurred during evacuation or treatment. I have read the description of the program and information provided for preparation and understand the nature of the program and risks involved.

I have read this document and understand the requirements for being a student of Psychedelic Sitters School and agree to comply with these expectations.

The information listed in the Emergency Contact Fields is accurate. An emergency contact is required to know you are attending the training program and is available by phone or email during the retreat experience.

Please select who will be participating...

Adult Minor(s)
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First Participant's Name

First Name*

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First Participant's Date of Birth*

First Participant's Emergency Contact Information

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First Participant's Signature*

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Second Participant's Name

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Second Participant's Date of Birth*

Second Participant's Emergency Contact Information

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Third Participant's Name

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Third Participant's Date of Birth*

Third Participant's Emergency Contact Information

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Fourth Participant's Name

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Fourth Participant's Date of Birth*

Fourth Participant's Emergency Contact Information

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Fifth Participant's Name

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Fifth Participant's Date of Birth*

Fifth Participant's Emergency Contact Information

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Sixth Participant's Name

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Sixth Participant's Date of Birth*

Sixth Participant's Emergency Contact Information

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Seventh Participant's Name

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Seventh Participant's Date of Birth*

Seventh Participant's Emergency Contact Information

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Eighth Participant's Name

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Eighth Participant's Date of Birth*

Eighth Participant's Emergency Contact Information

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Ninth Participant's Name

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Ninth Participant's Date of Birth*

Ninth Participant's Emergency Contact Information

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Tenth Participant's Name

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Tenth Participant's Date of Birth*

Tenth Participant's Emergency Contact Information

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Participant's Address

Address Line 1:*

Street address, P.O. box, company name, c/o

Address Line 2:

Apartment, suite, unit, building, floor, etc.

Country:*

City:*

State/Province:*

Zip/Postal:*

Parent or Guardian's Email Address

Check to receive information, news, and discounts by e-mail.

A signed copy of this waiver will be sent to the email address you provide.

Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.

Parent or Guardian's Name

First Name*

Last Name*

Phone*

Parent or Guardian's Date of Birth*

Parent or Guardian's Emergency Contact Information

Name *

Relationship *

Phone Number *

Email Address *

Parent or Guardian's Signature*

Type Signature

Draw Signature

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Electronic Signature Consent*

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

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