Your Waiver / Intake Form

*This form is an example and does not constitute legal advice. You should consult with a legal professional to create a waiver that meets your specific needs.

1. Assumption of Risk

I, the undersigned Participant, understand that participating in the retreat hosted by Pocketstones LLC d/b/a World Shamans, Naylin Amanda, and Shamanic Reiki involves inherent physical, structural, environmental, and activity-related risks.

I specifically acknowledge and agree that the venue premises at Smokebrush Farm Foundation (Onaledge Lodge and Rockledge Manor) consist of steep, rocky, and uneven terrain, as well as historic/older structures featuring stairs, multi-level pathways, and varied step heights.

These risks include, but are not limited to:

• Navigating steep incline paths, rocky ground, unpaved trails, garden terraces, ledges with drops,steps, steps that are uneven and made of rock, and interior or exterior staircases.

  
  

• Physical activities, movement, stretching, walking, hiking, standing, breathwork, sitting, energetic practices and spiritual practices.

  
  

• Exposure to smoke, incense, herbs, smudging materials, essential oils, fragrances, or other ceremonial materials and practices, which may cause sensitivity, irritation, allergic reactions, respiratory symptoms, headaches, dizziness, or other reactions.

  
  

• Use of venue facilities, lodging, accommodations, grounds, and natural surroundings. Use of the hot tub and other amenities available on the property, including risks associated with wet or slippery surfaces, entering and exiting the hot tub, water temperature, dehydration, overheating, dizziness, falls, or other injury or illness.

  
  

• Exposure to changing or severe weather conditions, including rain, snow, ice, wind, heat, cold, lightning, and wet or slippery surfaces.

  
  

• Exposure to wildlife, insects, plants, rocks, trees, and other naturally occurring conditions associated with the property and surrounding outdoor areas.

  
  

• Risks associated with elevation and altitude, including shortness of breath, dizziness, fatigue, headache, dehydration, or other altitude-related symptoms.

  
  

• Food-related risks, including food sensitivities, food allergies, dietary restrictions, cross-contact with allergens, or adverse reactions to meals, beverages, ingredients, or food provided during the retreat.

  
  

• Travel to, from, or around the property, as well as any off-site excursions or outdoor activities during the retreat dates.

  
  

• Unforeseen environmental conditions, physical injuries, slips, trips, falls, illnesses, burns, or loss/damage of personal property.

I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the Host or others, and assume full responsibility for my participation.

2. Nature of Services, Personal Autonomy, Disclaimers, and No Guarantee of Results

I understand and agree that all services, ceremonies, sessions, activities, and offerings provided through Pocketstones LLC d/b/a World Shamans, Naylin Amanda, Shamanic Reiki, or any guest facilitators, visiting elders, shamanic healers, or members of the Q’ero community—including but not limited to ceremony, shamanic healing sessions, energy work, sound healing, breathwork, or any other spiritual offerings—are complementary, spiritual, educational, wellness-oriented, and entertainment in nature.

By participating in this retreat, I agree to the following:

Not a Substitute for Professional Services: I explicitly acknowledge that no services provided at the retreat are intended to be, nor should they ever be used as a substitute for, professional medical advice, medical diagnosis, medical treatment, clinical psychotherapy, psychiatric care, counseling, licensed mental health care, or professional financial, legal, or medical decision-making.

No Medical or Clinical Relationship: Neither the Host nor any facilitators, healers, guest leaders, visiting elders, or members of the Q’ero community are acting as licensed medical professionals, physicians, clinical psychologists, or licensed psychotherapists in connection with the retreat offerings.

Personal Responsibility for Healthcare: I understand that it is my sole responsibility to seek professional advice from a licensed physician, psychiatrist, or mental health provider regarding any medical, physical, mental, or emotional health conditions.

No Guarantee of Results: I acknowledge that the Host, facilitators, guest leaders, visiting elders, shamanic healers, and members of the Q’ero community make no guarantees, promises, or representations concerning specific physical, emotional, spiritual, or mental outcomes or results from

attending this retreat or participating in any sessions.

Personal Accountability and Decision-Making: I acknowledge that I am fully accountable and personally responsible for my own choices, actions, decisions, well-being, and life choices before, during, and after

the retreat.

Personal Interpretation and Beliefs: I remain fully free to interpret and integrate my experiences according to my own personal, cultural, religious, spiritual, philosophical, or secular beliefs.

No Mandatory Belief System: I acknowledge and understand that I am never required to adopt any particular belief system, spiritual practice, worldview, or doctrine.

3. Voluntary Participation and Ceremonial Consent

I understand that if I choose to participate in any ceremonial, spiritual, shamanic healing practices, meditation, breathwork, energetic sessions, or other group/individual offerings during this retreat, my participation is voluntary.

Voluntary Engagement: I acknowledge that my participation in any retreat events, ceremonies, workshops, sessions, and activities is completely voluntary.

Right to Opt Out: I understand that I am not required to attend or participate in any specific event, ceremony, or workshop.

Freedom to Leave: I retain full personal authority to opt out of, decline, step away from, or leave any ceremony, session, or activity at any time, for any reason, without pressure or requirement to justify my decision.

4. Physical and Mental Fitness

I confirm that I am capable of safely participating in this retreat and understand that I am responsible for determining whether participation is appropriate for me. I acknowledge that it is my responsibility to consult with a physician prior to participating if I have any medical concerns. I agree to listen to my body, participate within my own self-assessed limits, and immediately discontinue any activity if I experience discomfort or distress.

5. Release and Waiver of Liability

In consideration for being permitted to participate in the retreat, I hereby release, waive, discharge, and covenant not to sue Pocketstones LLC d/b/a World Shamans, Naylin Amanda, Shamanic Reiki, their

officers, facilitators, independent contractors, agents, guest facilitators, visiting elders, shamanic healers, and members of the Q’ero community (collectively,"released parties") from any and all liability, claims, demands, actions, or causes of action arising out of or related to any loss, injury, illness, or damage (including death) that may be sustained by me or my property while participating in the retreat or while on the premises.

Additional Waivers: I understand that the retreat center and/or individual facilitators may require me to review and complete additional waivers, releases, or participation agreements upon check-in or before

participating in certain activities or services.

6. Emergency Medical Authorization

In the event of a medical emergency or injury during the retreat, I authorize the Host and its representatives to secure emergency medical treatment on my behalf if I am unable to do so.

I agree to be fully responsible for any medical costs incurred. I agree to provide accurate emergency and medical information to the best of my knowledge, including emergency contact information, when requested by World Shamans.

7. Non-Refundable Deposit and Cancellation Policy

I acknowledge and agree to the following cancellation terms and refund schedule:

Non-Refundable Deposit: A $400 non-refundable deposit per person is required at the time of booking to secure your reservation.

Cancellations On or Before May 29, 2027: If you cancel on or before May 29, 2027, you will receive a refund of all payments made, less the $400 non-refundable deposit.

Cancellations May 30–July 29, 2027: If you cancel on or after May 30, 2027 and on or before July 29, 2027, you will receive a 50% refund of all payments made after deducting the $400 non-refundable deposit per person.

Cancellations On or After July 30, 2027: No refunds will be issued for cancellations made on or after July 30, 2027. All payments are non-refundable.

Written Cancellation Requirement: All cancellation requests must be submitted in writing via email directly to naylin@shamanicreiki.com.

No Transfers or Late Credits: No refunds, partial credits, or balance transfers will be issued for late arrivals, early departures, missed sessions, or no-shows.

Travel and Event Insurance Recommendation: I understand that the Host strongly recommends purchasing third-party travel and trip cancellation insurance to cover unexpected circumstances, including illness, emergency, or personal changes that may prevent my attendance.

8. Accommodation and Room Selection Review

I confirm that I have carefully reviewed my selected room tier, bedding setup, occupancy arrangements, and accommodation details prior to signing. I specifically acknowledge and accept that:

• Lodging is provided within historic, older residential structures (Onaledge House and Rockledge House).

• The structures feature narrow staircases, multi-level layouts, and architectural characteristics typical of historic homes.

• The buildings naturally produce sound, including creaking floors, settling noises, and acoustic carrying between rooms.

  
  

• Specific room assignments, shared or private bathroom configurations, and layout details are accepted as presented.

9. Media & Photo Release

Photography, Video & Audio: I understand that photographs, video, and audio recordings will be taken during the retreat by or on behalf of Pocketstones LLC d/b/a World Shamans. By participating in the retreat, I understand and agree that I may appear in photographs, video, or audio recordings taken during retreat activities, gatherings, and ceremonies, and I give permission for my image, likeness, or voice to be used for website, marketing, promotional, or educational purposes without compensation.

Right to Opt Out: I understand that I have the right to opt out of appearing in or having my image, likeness, or voice used in retreat media. If I do not wish to be photographed, filmed, recorded, or included in media used by World Shamans, I am responsible for notifying the Host of my decision. Choosing to opt out will not affect my ability to participate in the retreat.

Participant Photography & Recording: Participants may take photographs during ceremonies. Participants are not permitted to take video or audio recordings during ceremonies or private sessions with the Q’ero.

Third-Party Use: I understand that if photographs, videos, or recordings containing my image, likeness, or voice are published or shared publicly, Pocketstones LLC d/b/a World Shamans cannot control or be responsible for how that content may later be copied, shared, reproduced, or distributed by third parties.

10. Code of Conduct, Respect for Cultural Viewpoints, Right to Remove, and Law Enforcement

I acknowledge that maintaining a safe, respectful, and honorable environment is fundamental to the retreat experience.

Respect for Cultural and Spiritual Viewpoints: I agree to approach all ceremonies, elders, facilitators,and participants with dignity, honor, and respect. I acknowledge that the retreat hosts a diversity of spiritual perspectives, cultural traditions, and personal backgrounds. Mockery, intentional disrespect, cultural intolerance, or disparagement of indigenous traditions, ceremonial practices, or fellow

participants beliefs will not be tolerated.

Zero Tolerance for Sexual Harassment and Inappropriate Conduct: Sexual harassment, unwanted physical contact, non-consensual sexual advances, sexualized remarks, boundary violations, stalker-like behavior, intimidation, bullying, or verbal/physical abuse toward any participant, facilitator, guest elder, staff member, or venue personnel will not be tolerated under any circumstances.

Host Authority and Right to Remove: The Host reserves the absolute right to immediately dismiss, remove, and require any participant to

vacate the retreat premises at any time, at the participant's sole personal expense, without refund or credit, for engaging in cultural disrespect, sexual harassment, inappropriate conduct, substance misuse, property damage, or any behavior that compromises safety or group well-being.

Notice of Law Enforcement Intervention: If a participant engages in unlawful conduct, sexual assault, harassment, trespasses by refusing to leave after dismissal, or poses an active danger to self or others, the

Host reserves the full legal right to contact local law enforcement authorities (e.g., Manitou Springs Police / El Paso County Sheriff) to remove the individual or enforce legal remedies.

11. Schedule Flexibility and Itinerary Adjustments

I understand and acknowledge that the retreat schedule, itinerary, session times, activities, outdoor excursions, and ceremonial programming are fluid and subject to change at the sole discretion of the Host.

I understand that modifications may occur due to:

• Weather conditions or environmental safety.

• Safety, health, or energetic needs of the group or individual participants.

• Venue requirements, facility logistics, or property constraints.

• Emergencies, sudden illness, or unforeseen operational considerations.

• Needs or guidance of visiting guest elders, healers, or facilitators.

  
  

I agree that schedule modifications, adjustments, delays, or session substitutions do not constitute a breach of contract or entitle me to any partial refund, discount, or monetary compensation.

12. Force Majeure and Acts of God

Neither the Host, facilitators, nor venue owners shall be held liable or responsible for any failure, delay, modification, cancellation, or interruption of the retreat resulting from acts beyond their reasonable

control (Force Majeure Event).

Covered Events: Force Majeure events include, but are not limited to: severe weather events, wildfires, floods, natural disasters, severe winter conditions, road closures, government emergency orders, travel

restrictions, public health emergencies, epidemics, pandemics, utility outages, acts of terrorism, civil unrest, or venue destruction/unavailability beyond the control of the Host.

No Monetary Refunds: In the event of cancellation, modification, or interruption due to a Force Majeure Event, the Host shall not be obligated to issue cash or monetary refunds.

Rescheduling or Credit Options: If the retreat is cancelled in full prior to commencement due to Force Majeure, the Host may, at its sole discretion, issue retreat credits toward rescheduled dates or future offerings, minus non-recoverable operational expenses already incurred by the Host.

Participant Travel Insurance: Participants are solely responsible for obtaining their own trip cancellation and travel insurance to mitigate financial loss associated with unforeseen external disruptions.

13. Property Loss, Damage, and Personal Belongings

I understand and agree to the following protections regarding property loss, theft, breakage, and damage during the retreat:

Personal Belongings Disclaimer: Pocketstones LLC, Naylin Amanda, World Shamans, Shamanic Reiki, and Smokebrush Farm Foundation assume no liability or responsibility for the loss, damage, destruction, theft, or disappearance of my personal belongings, luggage, valuables, equipment, or items left unattended on the venue premises, in accommodations, or in vehicles.

Participant Responsibility for Damage or Breaking: I agree to accept full financial responsibility for any damage, breakage, destruction, misuse, or vandalism caused by my intentional or negligent actions to

the venue facilities, historical structures, furniture, ceremonial equipment, or property belonging to Pocketstones LLC, Naylin Amanda, World Shamans, Smokebrush Farm Foundation, or fellow participants.

Indemnification for Property Claims: I agree to indemnify and hold harmless Pocketstones LLC, Naylin Amanda, World Shamans, and Shamanic Reiki against any claims, losses, repairs, replacement costs, or legal fees resulting from property damage or breakage caused by me during the retreat.

14. Governing Law and Forum Selection

This Agreement shall be governed by and construed in accordance with the laws of the State of Colorado. Any legal action or proceeding arising out of or relating to this Agreement shall be brought exclusively in the courts of El Paso County, Colorado. If any provision of this Agreement is held to be invalid or unenforceable, the remaining provisions shall continue in full force and effect.

15. Opportunity to Ask Questions

I confirm that I have had full opportunity to ask any questions I may have regarding the retreat, its accommodations, policies, activities, and services prior to signing this document, and that all such questions have been answered to my satisfaction.

By typing my full legal name below, I acknowledge that I have read, understand, and agree to the terms of this Agreement and that my typed name serves as my electronic signature.

If I am registering another participant, I confirm that they are aware of and agree to the terms of this Agreement.