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I seek to participate and join the ceremonial works of NovaLuz. I understand that the NovaLuz operates under the guidelines indicated within this process and I hereby agree to complete this application, the confidential medical history form and legal waiver. I understand that the NovaLuz holds the safety of its participants above all and I will comply in assisting this endeavor.

I am assured that the information obtained herein is used to determine if it is appropriate for the undersigned to participate in this Work. I further understand that all information contained herein will remain strictly confidential.

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Waiver Liability

PLEASE READ THIS FORM CAREFULLY. THIS IS A BINDING LEGAL DOCUMENT.

This release says that you know that participating in a religious ceremonial works which involves the ingestion of a holy sacrament, ie. Daime (other known as Ayahuasca) 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 the ceremonial works of ‘Nova Luz’ is purely voluntary, I agree to remain to the closing of a sacramental Daime ceremonial work I choose to begin.

During the Work I will ingest an entheogen, the sacred sacrament known as Santo Daime or Ayahuasca. This substance is a natural extract of plants which grows throughout 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 facilitators of Nova Luz. I have been attracted to the Work as a result of research, personal reports, and information as well as the potential for a profound spiritual experience. I understand that Nova Luz will make no claim or promise regarding the curing of any illness or the nature of any spiritual experience.

I understand that the practice of this ceremony is inspired and originated in the Santo Daime Religion founded and originating in Brazil. I understand that the Work 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 Work 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 and 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 the Work. I acknowledge that it is my responsibility to arrange alternate transportation, if needed at the conclusion of the Work and/or stay for the duration of recovery (over night) to ensure my safety and that of others. I hereby knowingly 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 of the Work organized by or on the property of Nova Luz.

I hereby waive the liability of and agree to hold harmless Nova Luz, including all of its founders, members, associates, employees, agents, staff, family, successors, volunteers, and other participants. I further agree to defend and indemnify them from any claims, suits, and demands. I understand that this agreement is binding upon me, my spouse, parents, family, heirs, executors, administrators, agents, and assigns.

If you have a history of psychosis or psychotic episodes you may be particularly susceptible to an adverse reaction in using the sacrament, i.e. the Daime tea or Ayahuasca, and we encourage you to seek the advice of a health care professional if you fall within this category, and to let the Nova Luz leader know of your history. These communications shall take place before any ingestion of the sacrament or arriving to participate in a ceremony. Please direct any communication to Nova Luz contact person who has given you this document.