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Mesa Student Waiver and Release Form

I,

(Hereinafter “Releasing Party”) HEREBY WAIVE AND RELEASE, indemnify, hold harmless and forever discharge The Chacana Spiritual Center, LLC (hereinafter “Released Party”) and its agents, employees, instructors, officers, directors, affiliates, successors and assigns, of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that I ever had or may have, arising from or in any way related to my participation in any of the events or activities conducted by, on the premises of, or for the benefit of, Releasing Party provided that this waiver of liability does not apply to any acts of gross negligence, or intentional, willful or wanton misconduct.


Releasing Party understand that the activities in which Releasing Party will participate are potential dangerous- shamanic classes, workshops, fire ceremonies, other workshops & energetic healing and general training and/or may involve movements, contortions, and actions that may cause discomfort and possible injury as well as possibly subject to illness from actions including but not limited interactions with floor with bare feet or bare hands- but that it is my responsibility to wear proper attire, listen to all instructions, cease all activities if Releasing Party feel any discomfort, concern for Releasing Party’s well-being and advise the instructor of any issues and that even with these protections, the activities may still result in serious or grievous injuries, including bodily injury, damage to personal property and/or death. On behalf of myself, my heirs, assigns and next of kin, Releasing Party waives all claims for damages, injuries and death sustained to me or my property that Releasing Party may have against the aforementioned Released Party to such activity.


By this Waiver, Releasing Party assumes any risk, and take full responsibility and waives any claims of personal injury, death or damage to personal property associated with the Released Party including but not limited to receiving, shamanic classes, workshops, fire ceremonies, other workshops & energetic healing, and general training for the aforementioned activities, or using the facility and its equipment or other related activities on and off the premises, if applicable.


This WAIVER AND RELEASE contains the entire agreement between the parties and supersedes any prior written or oral agreements between them concerning the subject matter of this WAIVER AND RELEASE. The provisions of this WAIVER AND RELEASE may be waived, altered, amended or repealed, in whole or in part, only upon the prior written consent of all parties.


The provision of this WAIVER AND RELEASE will continue in full force and effect even after the termination of the activities conducted by, on the premises of, or for the benefit of, whether by agreement, by operation of law, or otherwise.


Florida law shall govern this Waiver and all claims which in any way relate to or arise out of the Waiver or any of the dealings of the parties hereto. In any suit brought by either party, which in any way relates to

or arises out of this Waiver, or any of the dealings of the parties hereto, both parties’ consent and agree to venue and personal jurisdiction in the state of the city or county of the Released Party’s office, presently Brevard County, Florida.


Releasing Party have read, understand, and fully agree to the terms of this WAIVER AND RELEASE.


Releasing Party understand and confirm that by signing this WAIVER AND RELEASE I have given up considerable future legal rights. Releasing Party have signed this Agreement freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to me. My signature is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability to the full extent of the law. Releasing Party is 18 year of age or older and mentally competent to enter into this waiver.

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