PROJECT LIFE SPARK
WAIVER AND RELEASE OF LIABILITY

WAIVER OF RIGHTS
I, the undersigned participant, am executing this Waiver of Rights and Release of Liability as of today’s date marked below in favor of Project Life Spark, a Canadian company, and its members, managers, directors, officers, affiliates, employees, volunteers, successors, assigns, and agents (collectively, "Project Life Spark").

I accept the conditions of participating in plant medicine sessions facilitated by Project Life Spark’s trusted partners in Mexico, and I declare that I am choosing to participate of my own free will. I have not been coerced into participating in sessions by the organizers or by any other person; the decision to participate is mine alone, and is based on my own personal assessment of the effects, exclusion criteria, potential risks and benefits, the focus of the session, and the commitment of the facilitators.

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TREATMENT AND ENTHEOGENS
I understand I will receive treatment that includes plant medicines including but not limited to Ibogaine, 5-MeO-DMT, and psilocybin (the "entheogens") and associated therapies (all together, the "Treatment").

• Ibogaine: An alkaloid derived from the root bark of the African shrub Tabernanthe Iboga or the Voacanga plant. Ibogaine is legal in Mexico but remains a controlled substance in Canada.

• 5-MeO-DMT: A psychoactive compound found naturally in plants and the secretion of the Bufo Alvarius toad. It can also be produced synthetically. 5-MeO-DMT is legal in Mexico but remains a controlled substance in Canada.

• Psilocybin: The psychoactive compound found in certain mushroom species. Psilocybin is available for therapeutic use in Canada under specific legal exemptions.

I acknowledge that Ibogaine and 5-MeO-DMT treatments will take place in clinical facilities in Mexico, where these substances are legal. Psilocybin therapies may take place in approved facilities within Canada or the United States. I further understand that these plant medicine sessions will not be conducted by Project Life Spark directly but by its trusted partners in Mexico or at approved facilities in Canada or the United States.

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RELEASE
By signing this Release, I confirm that I have read and understood the nature and risks of participation. I acknowledge that I have been informed of the potential benefits and risks associated with these therapies.

I confirm that I can decide whether or not to participate in a free and informed manner.

I am aware that I can ask questions about the session at any time and can change my mind about attending at any time before the session begins. Once the session has started, I commit to following the facilitator’s guidance and protocols for my safety and well-being.

I confirm that I am of sound mind and body to sign this Release.

I agree to provide all relevant information about my medical history, mental and physical health, and any other details necessary to ensure my safety during this process.

 

AGREEMENT TO TERMS OF PARTICIPATION
I am voluntarily participating in this treatment and confirm that I am over the age of 18.

I hereby state that I currently have no physical illness or serious psychiatric disorder.

I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular trac, consumption of plant medicines including but not limited to Ibogaine, 5-MeO-DMT, and psilocybin, lack of hydration, excessive hydration and actions of other people including, but not limited to, participants, volunteers, monitors, and producers of the activity. These risks are not only inherent to participants, but are also present for volunteers.

I have been informed that taking the entheogens in conjunction with psychotropic and other drugs/supplements is dangerous, hazardous, and can cause life-threatening symptoms, so I agree not to take any medication or drug before, during, or after the treatment that has not been already approved by our medical staff.

I understand that once treated with the entheogens, I will be more sensitive to narcotics and taking narcotics may cause medical endangerment, including death.I agree not to take any medication, drug, or supplement before, during, or after treatment unless approved by the medical team of the organization providing the treatment.

I confirm that I will not use or bring illicit substances to the treatment facility. I consent to a drug screening test to ensure compliance with safety protocols.

I agree that after discharge, I will seek medical attention if needed and follow through with aftercare recommendations.

I understand and agree to be monitored during the necessary time frames for the treatment.

I understand that I cannot consume any solid food 3-6 hours before taking the entheogens although I can have liquids such as water or fruit juice (barring grapefruit juice).

 

COMMON EXPERIENCES

I understand that the lists below suggest common experiences reported from those consuming the entheogens and that these are in no way a comprehensive list of side effects of each entheogen. I agree to do my own research and elect to participate in the treatment of my own free will.

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IBOGAINE:

Nausea and movement-induced vomiting. 

Ataxia (impaired motor coordination). 

Visual distortion. 

Decreased need for sleep for several days after ibogaine administration. 

Restlessness (which can last several hours). 

Impairment in concentration and verbal communication (usually experienced during the first 6-8 hours of the experience). 

I understand that all these side effects are transitory, and usually wear off completely after 24-36 hours, although the reduced need for sleep can last for several days. 

I am aware that Ibogaine can bring repressed memories and emotions to the surface. 

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 and confusion which may be caused by ibogaine ingestion. 

 

5-MeO-DMT:

Visual distortion.

An immediate onset within seconds of inhaling.

Entering other dimensions even if your consciousness stays present in the room

Feeling a blast off into infinity and divinity.

Seeing only darkness or sacred geometrical shapes.

Seeing visions, images, memories, or future moments (but not usually).

Transcendence beyond awareness.

High energy frequencies pulsating through your body.

The feeling of weightlessness, like you are flowing and connected to divine energy

Impairment in concentration and verbal communication (usually experienced during the first hour of the experience). 

 

PSILOCYBIN:

Visual distortion.

Typically a 20-60 minute onset.

Entering other dimensions even if your consciousness stays present in the room.

Seeing darkness or geometrical shapes.

Seeing visions, images, memories, or future moments.

Transcendence beyond awareness.

High energy frequencies pulsating through your body.

The feeling of weightlessness, like you are flowing and connected to divine energy.

Impairment in concentration and verbal communication.

 

PARTICIPANT DATA CONFIDENTIALITY AND MEDIA RELEASE
Project Life Spark and its partners will take steps to protect my confidentiality. My identity will not be disclosed without my written consent.  My signature of this Release specifically does not grant the staff 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 understand that while participating in this activity, I may be photographed or recorded. If I do not wish for my image to be used for any purpose, I will provide a written statement to Project Life Spark and/or its partner organization.

 

AGREEMENT TO RELEASE FROM LIABILITY
I understand that side effects or harm can be caused by participation in the treatment. I understand that even with the use of high standards of care, side effects or harm could occur during this treatment through no fault of mine or the staff involved. 

I desire to participate in the treatment. In consideration and exchange for being allowed to participate in the treatment, I hereby freely, voluntarily, and without duress execute this Release and agree to the following terms:

Assumption of Risk: I am aware and understand that the treatment may be inherently dangerous and may expose me to foreseen and unforeseen hazards and risks. I acknowledge that I am voluntarily participating in the treatment 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 treatment. 

Medical Treatment. I hereby give consent and authority to the partner organization to obtain medical treatment on my behalf if I am injured or require medical treatment during my participation in the treatment. I understand and agree that I am solely responsible for all costs related to such medical treatment, medical transportation, and evacuation. I acknowledge that any injuries that I sustain may be compounded by negligent emergency response or rescue operations of others. I hereby release, forever discharge, and hold harmless Project Life Spark from any claim whatsoever in connection with such treatment or other medical services.

 

Release and Waiver. I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THIS Project Life Spark, its partner organizations and its ceremonies, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous activities or defective equipment or property owned, maintained, or controlled by them, from my consuming of Ibogaine and 5-MeO-DMT, or because of their possible liability without fault. I certify that I am physically fit, have sufficiently prepared for participation in this treatment, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems or on any medications which preclude my participation in this activity. I acknowledge that this Waiver and Release of Liability Form will be used by Project Life Spark, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. I hereby fully and forever release and discharge Project Life Spark 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 treatment. I covenant not to make, initiate, or bring any such claim, lawsuit, court action, or other legal proceeding or demand against Project Life Spark, nor join or assist in the prosecution of any claim for money other or 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 treatment, and I waive any right I may have to do so. I fully and forever release and discharge Project Life Spark from liability under such claims or demands. I UNDERSTAND THAT THIS RELEASE DISCHARGES Project Life Spark FROM ANY LIABILITY OR CLAIM THAT I MAY HAVE AGAINST Project Life Spark WITH RESPECT TO ANY ACCIDENT, BODILY INJURY, EMERGENCY TREATMENT, PERSONAL INJURY, ILLNESS, DEATH, PROPERTY DAMAGE, PROPERTY LOSS, OR RESCUE OPERATION THAT MAY RESULT FROM THE treatment, WHETHER CAUSED BY THE ACTIONS, INACTIONS, NEGLIGENCE, OR OTHER FAULT OF Project Life Spark OR OTHERWISE. I waive my insurers’ right to make a claim against Project Life Spark based on payments by insurers to me or on my behalf for any reason, meaning my insurers have no right of subrogation against Project Life Spark.

 

 

Insurance. I UNDERSTAND THAT Project Life Spark 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 Project Life Spark in the event of any injury or medical expense.

 

Indemnification. I hereby agree to indemnify, defend, hold harmless, and reimburse Project Life Spark from any and all actions, awards, claims, costs, damages, deficiencies, expenses, fines, interest, judgments, liability, losses, penalties, or settlements, including legal fees and the cost of pursuing any insurance providers, that it may incur or sustain as a result of my participation in the treatment, arising out of any third-party claim. I will reimburse Project Life Spark if anyone makes a claim against Project Life Spark in connection with my participation in the treatment, including, without limitation, any accident I may be involved in or any injury, loss, damage to me, other parties, or property, however caused. 

 

Miscellaneous. I hereby agree that this Release represents the sole and entire agreement between Project Life Spark 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 insure to the benefit of Project Life Spark 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 forever. I have not withheld any information that would influence Project Life Spark's decision to allow me to participate in the treatment. I will follow any and all instructions, recommendations, and cautions 

 

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 Canada without reference to any choice of law doctrine, and I hereby consent to the exclusive jurisdiction of such courts.

 

PARTICIPANT’S AUTHORIZATION STATEMENT
I have read and fully understand this waiver and release. I am participating in this treatment freely and voluntarily.

By signing below, 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 Project Life Spark, without any inducement, assurance, or guarantee being made to me. I completely and unconditionally release all liability to the greatest extent allowed by law.

Signature: ____________________
Printed Name: ____________________
Date: ____________________