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WAIVER AND RELEASE OF LIABILITY FOR KAMBO CEREMONYwith Viva Kambo Tribe (8th Chakra Studio)

Date: ___________________________

Participant’s Full Name: ___________________________

Date of Birth: ___________________________

Email / Phone: ___________________________

1. Description of Activity I voluntarily request to participate in a Kambo ceremony facilitated by [Andre Sadoval & Mairsol Silva] on behalf of Viva Kambo Tribe. Kambo involves the traditional application of the secretion from the Phyllomedusa bicolor (giant leaf/monkey tree frog) to small burns (gates) on the skin. The ceremony is a sacred, non-psychoactive ritual rooted in Amazonian tradition. The practitioner has been trained in accordance with protocols and standards referenced on VivaKambo.org.

2. Voluntary Participation & Informed Consent I understand that participation is entirely voluntary. I have had the opportunity to ask questions and have received satisfactory answers. I am participating of my own free will and at my own risk.

3. Acknowledgment of Risks I understand and acknowledge that Kambo carries significant physical, emotional, and medical risks, including but not limited to:

  • Intense nausea, vomiting, diarrhea, and purging
  • Rapid heart rate (tachycardia), changes in blood pressure, dizziness, fainting, or swelling of the face/lips
  • Dehydration, electrolyte imbalance, or hyponatremia (especially if over-hydrating)
  • Headaches, abdominal cramping, fatigue, or flu-like symptoms
  • Rare but serious complications such as seizures, kidney or liver stress/damage, esophageal rupture, psychosis, syndrome of inappropriate antidiuretic hormone secretion (SIADH), or cardiac events
  • In extremely rare cases, severe adverse reactions or death have been reported in medical literature
  • Emotional or psychological effects, including temporary anxiety, emotional release, or intensified spiritual experiences

I confirm I have no contraindications, including (but not limited to):

  • Heart conditions, low or high blood pressure issues, or history of stroke
  • Pregnancy or breastfeeding
  • History of severe mental health conditions (psychosis, schizophrenia, bipolar disorder, severe depression/anxiety)
  • Recent major surgery, organ transplant, or serious illness
  • Use of certain medications (e.g., heart medications, diuretics, immunosuppressants, or any substance that affects blood pressure or fluid balance)
  • Any other condition that could be worsened by intense physical purging or peptide exposure

I have fully disclosed my complete medical history and current medications to the practitioner.

4. Assumption of Risk I fully understand and voluntarily assume all risks, known and unknown, associated with Kambo, including those caused by the practitioner’s actions or inactions (to the extent permitted by law). I agree that the benefits I hope to receive do not outweigh these risks.

5. Release of Liability & Waiver To the fullest extent permitted by California law, I hereby release, waive, discharge, and covenant not to sue Ayahuasca Hummingbird Church, its owners, practitioners, facilitators, volunteers, officers, agents, and affiliates (collectively “Released Parties”) from any and all liability for injury, illness, disability, death, loss, or damage arising out of or related to my participation in the Kambo ceremony, whether caused by negligence or otherwise.

This release includes, but is not limited to, claims for medical expenses, emotional distress, loss of income, or any other damages.

6. Indemnification & Hold Harmless I agree to indemnify, defend, and hold harmless the Released Parties from any and all claims, lawsuits, damages, losses, costs, or expenses (including reasonable attorney’s fees) brought by me, my heirs, family members, or any third party as a result of my participation.

7. No Medical Advice or Guarantees Kambo is a traditional ceremonial practice, not a medical treatment. The practitioner and Ayahuasca Hummingbird Church do not diagnose, treat, cure, or prevent any disease or condition. I understand there are no guarantees of any specific outcome. I agree not to rely on Kambo as a substitute for professional medical care. I have been advised to consult my licensed physician before participating.

8. Media & Confidentiality I consent to the possible recording or photographing of the ceremony for internal or educational purposes, provided my identity is protected if requested. I agree to keep the personal experiences of other participants confidential.

9. Governing Law & Severability This agreement shall be governed by the laws of the State of California. If any provision is held invalid, the remainder shall remain in full force.

10. Acknowledgment I have read this entire document carefully. I understand it is a legally binding contract that affects my legal rights. I sign it freely and without duress.

This release declares that you understand that participating in a Kambo Ceremony may involve discomfort and unexpected physical, mental or emotional upset.

By signing this release agreement you are waiving all rights to seek or receive compensation in case of injury, loss or damage. * I understand that, although my participation in an Kambo Ceremony is purely voluntary, I agree to remain to the closing of a Kambo Ceremony which I choose to begin. * During the Ceremony, I will voluntarily receive a substance known as Kambo. This substance is a natural secretion of the phyllomedusa bicolor, or giant monkey frog, native to the Amazon Basin in South America. I have been informed of its effects, as well as, the objectives of taking it within the ritual led by experienced Kambo leaders. I have been attracted to the Ceremony as a result of research, personal reports, and information as well as the potential for a profound spiritual experience.

*I understand that the facilitators will make no claim or promise regarding the curing of any illness or the nature of any spiritual experience.

*I understand that the Ceremony is personal and sacred to each individual and that what may occur for one person, may not necessarily lead to the same experience in others.

* I understand that the Ceremony in which I choose to participate may be physically, mentally, emotionally, or spiritually demanding.

*I understand that I may experience dizziness, nausea, or other physical upsets including vomiting and diarrhea. I accept full responsibility for anything that may occur including emotional disturbance, mental disorientation and any and all possible manifestations of physical, emotional mental changes.

I acknowledge that the risks and potential benefits of my participation have been explained to me, and I freely choose to enter this process accepting full responsibility for whatever may occur, anticipated or unanticipated.

I understand I may be physically or mentally exhausted and/or disoriented after a Ceremony. I acknowledge that it is my responsibility to arrange alternate transportation, if needed at the conclusion of a Ceremony. I hereby acknowledge and voluntarily assume the full risks of any physical or other injury, damage or losses, either to myself or caused to others by me during any Ceremony organized by or held on the property of the facilitators.

I hereby waive the liability of and agree to hold harmless the facilitators, including all of its founders, members, associates, employees, agents, staff, family, successors, volunteers, any and all property owners where the Ceremony occurs, and other participants. 

I further agree to defend and indemnify them from any claims, suits or demands. I understand that this agreement is binding upon me, my spouse, parents, family, heirs, executions, administrators, agents and assigns. 

Participant Signature: _______________________________ Date: _______________

Printed Name: ______________________________________

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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.


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