Placeholder

Kambo Practitioner Training Application Deposit

$600.00

Please complete the form below if interested in applying.
  • Contact Info
    Where do you currently live

    *Emergency Contact

    Background info

    *Gender

    Please check any/all active social media profiles you have

    *Or you currently on - or have you ever been on the Sex Offenders Register?

    *Do you have a current passport?

    Please check below to confirm your understanding that a current passport (at time of arrival and departure from Peru) is required for attendance on the training. If you are unable to attend because of an expired passport, no refunds will be given and no credits towards future trainings will be applied.

    Medical Training

    *Do you have any medical training?

    *Do you have a current certification in First Aid / CPR?

    *Do you have any training as psychotherapist - or a degree in psychology?

    Health/Medical Info

    Sapo or Kambo has no known damaging side effects, so when it is responsibly administered it is completely safe. However, there are a few people who can't take it so please let us know beforehand if you have serious health problems

    Are you / Do you suffer from / Have you had

    *Pregnant or think that might be pregnant?

    *Breastfeeding a child under 1 years old?

    *Any serious heart conditions including pacemaker, defibrillator, valve disease, blood clots, bypass surgery and/or enlarged heart?

    *High or low blood pressure?

    *A stroke, aneurysm or bleeding in the brain?

    *Addison’s disease?

    *Ehlers-Danlos syndrome?

    *Organ transplant surgery?

    *Epilepsy (or prone to seizures)?

    *Ulcers?

    *Recent operations or fractures?

    *Anxiety/Psychotic disorder?

    *Any dysfunction of the nervous system?

    *Cancer?

    *Inflammation?

    *Hernia?

    *Taking medication for low blood pressure?

    *Undergoing/undergone chemotherapy or radiotherapy?

    *Taking any immune-suppressants for organ transplant?

    *Undiagnosed pain?

    *Any type of infection or disease?

    Please elaborate on any of the above checked conditions or treatments.

    *Will you be at the end of a fast or fasting during your course?

    *Have you ever been hospitalized?

    *Do you currently have a serious mental illness or have you ever been treated for a serious mental illness?

    *Are you currently or have you ever received therapy, attended a support group, and/or worked with a counselor, psychiatrist, psychologist or psychotherapist?

    *Is there anyone in your family with a history of psychiatric disorders?

    *Have you experienced traumas in your life? This includes traumatic events as well as ongoing traumatic experiences.

    *Do you drink alcohol?

    If YES, are you willing to fully detox off of any alcoholic substances a minimum of seven (7) days prior to your course?

    *Do you smoke?

    If YES, are you willing to either cease smoking or smoke all natural cigarettes?

    *Do you use any "illegal" substances?

    If YES, are you willing to fully detox off of any substances a minimum of seven (7) days prior to your course?

    *Have you used Bufo Alvarius in the last six (6) weeks?

    *Are you taking ANY western medical prescriptions, over-the-counter, or alternative, homeopathic medications or taking herbal supplements? If so, please list below and explain

    Kambo experience

    *Have you ever served Kambo?

    Please tell us which experiences you have had in the past. Check all that apply:

    Post-Training

    *Would you be interested in joining Tribal Teachings for a post-training plant dieta? (Separate costs would apply and additional deposits required)

    Our current Practitioner course requires you to self-administer a minimum of two (2) times a week for three (3) weeks upon returning from the training - you are not allowed to administer to others during this time. After three weeks, you must serve with small groups of 6 maximum and also continue to self-administer a minimum of one (1) time every week. You will also be required to journal about your experiences. Please check below to confirm that you understand these ongoing requirements.

    Fast forward to your future existence as a properly trained Kambo provider and server. What are the three best characteristics you will personally bring to the Kambo experience for your clients, and the Kambo community in general?

    *Digital Signature

    *Application Agreement

    *Refund / Cancellation Policy

    Model Release

    Please answer yes or no to the following statement: I hereby give Tribal Teachings permission to use my photographic likeness in images or videos taken during this retreat on their website, in print material or other broadcast media for the use in promotion of their projects and programs.

    Participation waiver and release

    Before provider will agree to provide Kambo and allow you to attend the Kambo Practitioner Training, this form must be read and signed by the participant.

    Participant acknowledges that they will be and have been truthful in giving full disclosure of their mental and physical health conditions. Participant has reviewed any literature provided and may have done some independent research of their own; and has asked Provider all questions they have regarding Kambo and the Kambo Practitioner Training Program. Participant acknowledges that they understood and are happy with the information and answers provided. That you are not under the influence of any drugs or alcohol, that you are not impaired in any way that would affect your decision making and that you are not under any duress. That you freely and voluntarily give permission to Provider to provide you with a Kambo session and the Kambo Practitioner Training now and in the future. That the Provider is not a medical professional and Kambo is not approved by the government as a medical treatment. That no results are guaranteed from Kambo sessions.

    Kambo does have significant effects on your body and these have been reviewed by you. In rare cases Kambo can result in loss of consciousness. By signing below you give permission to Provider to use the training they have had to help you regain consciousness in such an event, and if, in the judgment of the Provider you should require medical treatment, you also give permission for medical professionals to be called to provide necessary treatment to you.

    In consideration of the services provided by the Provider, Participant releases all claims against Provider. The undersigned acknowledges, appreciates, and agrees that:

    1.  The risk of being harmed from Kambo can be significant in rare cases, including the potential for permanent disability and death, and while the Provider’s training reduces the risk, the risk of serious injury does exist; and,
    2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
    3. I willingly agree to comply with the program’s stated and customary terms and conditions for participation.,
    4. I for myself, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE PROVIDER, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my participation in the Kambo sessions and Kambo Practitioner Training, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
    5. I, for myself, and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all of the above Releasees from any and all liabilities incident to my participation, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.
    6. I certify that I do not suffer from any health conditions that would prohibit my participation in Kambo sessions and the Kambo Practitioner Training, and hereby consent and allow Provider to proceed with the Kambo session(s) and Kambo Practitioner Training under the terms and conditions provided herein including all the Releases, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless Provider and all personnel connected therewith, from any and all liability from any claim that arises out of decisions made per this release and all damages resulting from participation in the Kambo session(s) and Kambo Practitioner Training as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE.

    *Date

Category:

There are no reviews yet.

Be the first to review “Kambo Practitioner Training Application Deposit”

Your email address will not be published. Required fields are marked *

Related products