Terms & Conditions
INFORMED CONSENT, RELEASE OF LIABILITY, AND WAIVER OF RIGHTS
I, the undersigned participant, am executing this Informed Consent, Release of Liability, and Waiver of Rights ("Release") as of the date below in favor of EQNMT Psych Inc. and their respective members, directors, officers, owners, affiliates, employees, contractors, volunteers, successors, assigns, and agents, including, but not limited to the staff at any Retreat such as facilitators and other support persons, (collectively, "EQNMT"), as a condition of my acceptance of certain wellness services, including, but not limited to, psychotherapy, coaching and instruction on meditation, yoga, breathwork, cold exposure, and other well-being practices (the "Services") delivered to me by EQNMT before, during and after my attendance of a retreat organized by EQNMT at its leased facilities in Ocho Rios, St Mary Parish, Jamaica, or (b) any other jurisdiction where EQNMT may lawfully offer its Services ((a), or (b), as applicable the “Retreat"). For the sake of clarity, the Services for Retreats include catering and workshops provided by EQNMT and Retreat staff at each Retreat facility.
STATEMENT OF INFORMED CONSENT
I understand that if I accept the Services, I will be invited to participate in a psilocybin ceremony at the Retreat (the "Ceremony"), where I will be gifted psilocybin mushrooms and/or psilocybin-infused foods for ceremonial ingestion. I acknowledge and understand that, if I accept the invitation to participate in a Ceremony, the Services will include EQNMT’s and/or the Retreat staff's facilitation of the Ceremony and any other services performed by EQNMT and/or Retreat staff in connection with my participation, regardless of whether they are performed before, during or after the Ceremony. Psilocybin is a naturally occurring substance that is present in many species of fungi, especially including the genus Psilocybe, found on all continents. In the U.S. (and other national jurisdictions), psilocybin is not currently approved for human use outside of research settings, and is a restricted drug.
By signing this Release, I am confirming that I have read this Release prior to accepting the Services, attending the Retreat, and participating in the Ceremony. I understand the nature and risks of the foregoing acts. I am confirming that I have been informed by the staff about the nature and effects of the Services, the Retreat and the Ceremony, and I also confirm that I can decide whether or not to participate in a free and informed manner. I also understand and agree that the Services, Retreat, and the Ceremony do not constitute medical advice nor treatment, nor do they create a doctor-patient or therapist-patient relationship between myself and EQNMT.
I agree that I have disclosed all information pertaining to my physical and mental health in the EQNMT Application Form and, if anything changes, will promptly communicate to the staff all of my medical conditions and current medications, as well as ask any questions that I may have about the Services, the Retreat, and the Ceremony. I acknowledge and agree that if I have diabetes or any other issues with the regulation of my blood sugar, it is my responsibility to self-monitor my blood sugar as is medically appropriate for the maintenance of my physical health and wellbeing. I also acknowledge and agree that if I have any allergies, I will inform the staff of the Retreat about such allergies and how I manage or respond to any allergic reactions (including, but not limited to, informing such staff of the location of any emergency medication to be administered to me in the event of an allergic reaction), however I take full responsibility for ensuring that I am not exposed to such allergens. Furthermore, I acknowledge and agree that there are risks associated with the transformational breathwork occurring before, during and after each Retreat and/or Ceremony. I agree to consult with my physician prior to engaging in any EQNMT-facilitated breathwork before, during or after retreat if I have experienced any of the following or if I am at risk for any of the following: heart attack, angina, high blood pressure, cardiovascular disease, detached retina, glaucoma, seizures, epilepsy, aneurysm, stroke, asthma, mental illness.
AGREEMENT TO TERMS OF PARTICIPATION
I am over the age of 18 and I am voluntarily participating in the Services, Retreat and Ceremony. While participating in the Services, Retreat and Ceremony, I agree to abide by the Community Agreements of inclusive and respectful dialogue and participation towards any other person, including all EQNMT staff and retreat participants. I understand that if I do not abide by the Community Agreements, EQNMT and/or Retreat staff may limit my participation in Retreat events and/or ask me to leave the Retreat facility.
I hereby state that I have no history of psychosis nor have any of my immediate relatives had a psychotic disorder. I also state that I currently have no serious psychiatric disorder, nor have I suffered from suicidal ideation and/or attempted to commit suicide within the last 12 months.
I understand that the results of the Services, Retreat and Ceremony vary among participants, and that the effects of psilocybin may differ even among participants given the same dosage of psilocybin at the same Ceremony. I am aware that the effects of psilocybin also vary depending on the type of medications I am currently using. I confirm that I have been informed, and completely understand, that psilocybin is not approved as a medication under the laws of the U.S. and other jurisdictions. I understand and accept that my consumption of psilocybin at the Ceremony, if voluntarily disclosed by me or otherwise discovered, could expose me to certain potential penalties under the laws of my country of residence, including but not limited adverse immigration consequences if I am not a citizen of my country of residence, such as being denied re-entry after I attend the Retreat. I agree not to remove any psilocybin from the Retreat or Ceremony site if I choose not to consume it at the Ceremony. I understand that bringing (or even attempting to bring) any amount of psilocybin into the U.S. (or onto an aircraft bound for the U.S.) is prohibited by the federal Controlled Substances Act and subject to serious criminal penalties and fines; I also understand that other countries may have similar laws and penalties with respect to the use and/or importation of psilocybin.
I have been informed that taking psilocybin in conjunction with a psychotropic or other drug or supplement can be potentially dangerous, so I agree not to take any medication or drug immediately before, during; or immediately after the Ceremony that I have not notified the Retreat staff about. Notwithstanding any such notice I may or may not provide to Retreat staff, I understand that Retreat staff are not responsible for any adverse drug interactions I may experience if I consume psilocybin in combination with psychotropics or other drugs, medications, or supplements.
I confirm that I will not bring illicit substances or paraphernalia to the Retreat. I understand that if I experience distressing side effects of any sort during the course of the Services, Retreat or Ceremony, and I notify Retreat staff of such side effects, the Retreat staff will refer me to appropriate professional care or facilities.
I agree that, after participating in the Services, Retreat, or Ceremony, I will seek medical attention if health issues arise, and I will follow through with an aftercare program outside of the Services.
SOME COMMON SIDE EFFECTS OF PSILOCYBIN
I understand that the side effects of consuming psilocybin may include, but are not limited to, the following:
1. Nausea and movement-induced vomiting.
2. Ataxia (impaired motor coordination), and specifically dysmetria (inability to properly direct or limit motions).
3. Visual and perceptual distortions.
4. Changes in heart rate, including tachycardia.
5. Tremors (involuntary muscle contraction and relaxation).
6. Changes in blood pressure, including hypertension or hypotension.
7. Confusion, and impairment in concentration and verbal communication.
I understand that all of these side effects are transitory, and usually wear off completely after 6-8 hours.
I am aware that people have reported obtaining new perspectives on previous life events or discovering new recollections pertaining to previous life experiences after ingesting psilocybin. I am also aware that ingesting psilocybin can bring about unusual mood swings, intense emotions, out of the ordinary sensations in the body, and unusual thoughts and feelings of tiredness. While these experiences are described by most people as profound and beneficial, to some individuals, they may be frightening and may produce anxiety and confusion. By signing this Release, I hereby indicate my understanding and acceptance of the risks of anxiety, confusion or any other emotional distress which may be caused by psilocybin ingestion and any participation in the Ceremony.
I understand that the side effects identified above may not be an exhaustive list of all possible side effects or include the specific side effects that I may personally experience, and I commit that I will supplement the information in this Release with my own research on all potential side effects, and that I will confer with my own physicians and/or psychiatrists to identify any side effects to which I may be especially vulnerable. I understand that any suitability screenings performed by EQNMT and/or Retreat staff are not intended to serve as medical evaluations and are undertaken at the request of those Retreat staff facilitating the Ceremony and solely to ensure a safe and productive experience for all Retreat participants attending the Ceremony, and not to exhaustively assess your individual risk of experiencing side effects or identifying what those specific side effects may include.
PARTICIPANT DATA CONFIDENTIALITY
I understand that care will be taken to preserve confidentiality of all information obtained from me in the course of the Services, the Retreat, and the Ceremony. My identity will not be revealed in any way to anyone (other than EQNMT, Retreat staff, and others attending the Retreat) unless I specifically give permission by my written consent. My signature of this Release specifically does not grant the Retreat staff, EQNMT, or any of their agents, employees, consultants, or other paid or unpaid assistants to reveal my identity to any other person, institution, or agency. I agree that I will not disclose the identity of any of my fellow participants in the Retreat, including Retreat staff employed by the Retreat venue, without first obtaining the written consent of both EQNMT and the individuals whose identity I disclose to others.
AGREEMENT TO RELEASE FROM LIABILITY
I understand that side effects and/or harm can be caused by participation in the Ceremony and attending the Retreat. I understand that even with the use of high standards of care, side effects or harm could occur during and after the Ceremony or the delivery of certain Services through no fault of mine or the staff involved.
I acknowledge that many of the known side effects of psilocybin ingestion have been described in this Release, and may be reiterated to me in the verbal orientations given to me by the Retreat staff.
I desire to participate in the Services, the Retreat, and the Ceremony. In consideration and exchange for being allowed to participate, I hereby freely, voluntarily, and without duress execute this Release and agree to the following terms:
1. Assumption of Risk. I am aware and understand that my participation in the Services, Retreat and/or Ceremony may be inherently dangerous and may expose me to foreseen and unforeseen hazards and risks. I acknowledge that I am voluntarily participating in the Services, Retreat and/or Ceremony and have considered those hazards and risks. I hereby expressly and specifically accept and assume such hazards and risks, including any and all risk of injury, harm, loss, or death that I may incur as a result of my participation in the Services, Retreat and/or Ceremony.
2. Medical Treatment. I hereby give consent and authority to EQNMT to obtain medical treatment on my behalf if I am injured or require medical treatment during my participation in the Services, Retreat and/or Ceremony. I understand and agree that I am solely responsible for all costs related to such medical treatment, medical transportation, and/or evacuation. I acknowledge that any injuries that I sustain may be compounded by negligent emergency response or rescue operations of EQNMT, the Retreat staff or others. I hereby release, forever discharge, and hold harmless EQNMT and Retreat staff from any claim whatsoever in connection with such treatment or other medical services.
3. Release and Waiver. I hereby fully and forever release and discharge EQNMT from, and expressly waive, any and all claims (including negligence claims), demands, expenses, lawsuits, and any other liability of whatever kind or nature, either in law or in equity, of or to me, my property, or any other person, directly or indirectly arising from or in connection with my participation in the Services, Retreat and/or Ceremony. I covenant not to make, initiate, or bring any such claim, lawsuit, court action, or other legal proceeding or demand (each, a "Proceeding") against EQNMT and/or any of its staff, nor join or assist in the prosecution of any claim for money or other damages which anyone may have, on account of injuries (including death), losses, or damages, sustained by me, other parties, or my (or others") property in connection with my participation in the Services, Retreat and/or Ceremony, and I waive any right I may have to do so. Notwithstanding the foregoing covenant and waiver, I agree that if such claims or demands were brought by any party, the proper legal jurisdiction within which to bring them would in any case be the country in which I attend the Retreat. I fully and forever release and discharge EQNMT from liability under such claims or demands.
I understand that this release discharges EQNMT and/or any of its staff from any liability or claim that I may have against EQNMT and/or any of its staff with respect to any accident, bodily injury, emergency treatment, personal injury, illness, death, property damage, property loss, or rescue operation that may result from my participation in the services, retreat or ceremony, whether caused by the actions, inactions, negligence, or other fault of EQNMT or otherwise.
I waive my insurers' right to make a claim against EQNMT based on payments by insurers to me or on my behalf for any reason, meaning my insurers have no right of subrogation against EQNMT.
4. Insurance. I understand that EQNMT does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance of any nature in the event of my injury, illness, or death, or damage to or loss of my property.
I expressly waive any claim for compensation or liability on the part of EQNMT in the event of any injury or medical expense.
5. Indemnification. I agree to indemnify EQNMT and hold it harmless against any and all liabilities, including judgments, costs and reasonable counsel fees, that it may incur or sustain as a result of my participation in the Retreat and/or the Ceremony, arising out of any third-party claim.
6. Miscellaneous. I hereby agree that this Release represents the sole and entire agreement between EQNMT and me and supersedes all other prior or contemporaneous agreements, representations, understandings, and warranties, both written and oral, between us, with respect to the subject matter hereof. If any term or provision of this Release or the application thereof to any party or circumstance shall be held to be invalid, illegal, or unenforceable to any extent by any court of competent jurisdiction, that term or provision shall be deemed modified so as to be valid and enforceable to the full extent permitted in that jurisdiction, and such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Release or invalidate or render unenforceable such term or provision in any other jurisdiction. The invalidity of any such term or provision shall be deemed modified so as to be valid and enforceable to the full extent permitted. This Release is binding on and shall inure to the benefit of EQNMT and me and our respective heirs, executors, administrators, legal representatives, successors, and permitted assigns, and my spouse and next of kin, without limitation. Section headings are for convenience of reference only and shall not define, modify, expand, or limit any of the terms of this Release. The terms of this Release shall continue from this date and in perpetuity. I have not withheld any information that would influence EQNMT’s decision to allow me to participate in the Services, the Retreat, and/or the Ceremony. I will follow any and all instructions, recommendations, and cautions.
7. Governing Law. I hereby agree that this Release is intended to be as broad and inclusive as permitted, and that the words, terms, provisions, covenants, and remedies contained in this Release shall be governed by, interpreted in accordance with, and enforceable to the fullest extent permitted by applicable laws of the courts of Massachusetts without reference to any choice of law doctrine, and I hereby consent to the exclusive jurisdiction of such courts.
PARTICIPANT'S AUTHORIZATION STATEMENT
BEFORE PROVIDING MY CONSENT BY DIGITALLY SIGNING THIS RELEASE, THE PROCEDURE FOR THE SERVICES, THE RISKS, AND THE SIDE EFFECTS HAVE BEEN EXPLAINED TO ME FULLY, BOTH ORALLY AS WELL AS VIA THIS RELEASE. I HAVE BEEN ABLE TO ASK ALL QUESTIONS I HAVE HAD ABOUT THE SERVICES, AND MY QUESTIONS HAVE BEEN ANSWERED CLEARLY AND IN DETAIL. I FULLY UNDERSTAND THE ANSWERS PROVIDED TO ME. I HAVE READ AND FULLY UNDERSTAND THE INFORMATION IN THIS RELEASE, AND I AM PARTICIPATING IN THE SERVICES FREELY AND VOLUNTARILY.
BY DIGITALLY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTOOD ALL OF THE TERMS OF THIS RELEASE AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE EQNMT, WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME. I COMPLETELY AND UNCONDITIONALLY RELEASE ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
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