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Please select the event you would like to attend:
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Altar of the Chakana Ceremony - with Grandfather Awakolla Medicine - Dec 2, 2023 - w/ Andrea Calderón
Emergency Contact Name
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Relationship to Emergency Contact
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Is this your first ceremony with Awakolla / Wachuma / San Pedro medicine? (If YES, please send a WhatsApp message to Lisa at (210) 727-7528 for a short interview)
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Yes, first time
No
Please provide information of medical history, antidepressants or mental illness, recent surgeries, allergies, alternative medicines or recreational substances, special situations or health issues.
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Yes, sign me up
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I am requesting permission to participate in the program known as the "Ceremony at Spiral Dance Ranch"; using techniques, equipment and facilities, with supervision of healers and/or other program personnel. I recognize that although this program may have certain benefits, there also exists the possibility that I could sustain a serious, permanent injury or injury resulting in death as a result of my own negligence or the negligence of others. Understanding the potential benefits and risks involved, I voluntarily sign this Release and Waiver of Claims. I represent that I am not aware of any physical or medical condition which would prevent me from participating in an exercise program. Other than the representations and warranties contained in this Release and Waiver of Claims, no other representations and warranties have been made to me. Likewise, no oral understandings, statements, promises or inducements contrary to the terms of this release exist. Further, I recognize that there are heightened risks related to COVID-19 (and other viruses) and programs where close interpersonal contact is necessary. As such, I hereby warrant and agree that I have read, understood and agree to abide by the minimum standard health protocols for programs of this nature, as promulgated by the State of Texas. Now therefore, in consideration for access to the program’s healers, equipment and facilities, the sufficiency of which is hereby acknowledged, i hereby release, acquit and forever discharge the ceremony at spiral dance ranch program, its owners, representatives and employees from any and all claims, demands, losses and causes of action of any kind whatsoever, at common law, in equity, statutory or otherwise, that i may have or that may arise hereafter, directly or indirectly attributable to my use and/or enjoyment of the ceremony at spiral dance ranch program healers, equipment and facilities. This release and waiver of claims shall be binding on my representatives, heirs, estate and assigns. I hereby agree to indemnify and hold harmless the ceremony at spiral dance ranch program, its owners, representatives and employees from and against all claims, demands and causes of action of every kind and character, without limit and without regard to the cause or causes thereof or the negligence of any party or parties, which arise in connection with my use and/or enjoyment of the ceremony at spiral dance ranch program’s healers, equipment and facilities. I understand that there may be terrain that is potentially hazardous, including but not limited to: streams, ponds, pools, waterfalls; rocky, steep, uneven trails and grounds; steps and stairs. I understand that this workshop may be held on land home to a variety of wildlife, including snakes, bobcats, raccoons, foxes, skunks, coyotes and bears. I take full responsibility for any injury sustained when on or about said areas, and I agree to hold harmless Third Eye Tribe of Venus Rising and all facilitators for any injury or causes of action of every nature sustained while in or about the building(s) and premises in which the sessions are conducted, or during any walks or on or off-site excursions in which I participate. Lastly, During the Course of Third Eye Tribe's Workshops, there may be photos, audio recordings, and videos taken of teachers and participants. These photos, videos, and recordings may include discussions, including questions by participants and answers from facilitators. Personal sharing and process groups will not be recorded or photographed. These photos, audio recordings and videos will be used to support the work of Lisa Asvestas and Third Eye Tribe of Venus Rising. They will be posted on Facebook and other social media and in our newsletters. By completing this form, I acknowledge that I understand I may be included in photos, audio recordings and videos used in the above described manner by Third Eye Tribe and I hereby give my permission for such use. No further request for authorization of use will be issued by Third Eye Tribe of Venus Rising.
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I agree to Third Eye Tribe's release statement