To ensure your safety and maximize the benefits of your experience, kindly complete this questionnaire in detail. Your medical conditions, medications, supplements, life experiences, and habits that could potentially impact you are of utmost importance for us to be aware of. Please note that this Form is strictly confidential.

We are a community of individuals that meet regularly, practicing ways of deepening our connection to ourselves, our connection to one another, and our connection to Source. We believe we are all here on this plant to heal and grow. We believe in kind communication, mutual respect, discerning truth, and leading with love. We believe that all life is interconnected through nature's intelligent design and through our studies, we seek to unearth the wisdom held within her codes.

At times our practice involves using plants and prayers that help us connect in deeper ways. At each meeting members assume responsibility for their own health and well being and agree to follow the guidelines outlined by Nalaya Healing - verbal or written.

This Assumption of Risk, Release of Liability, and Indemnity Agreement (“Agreement”) is entered into between Willa Kveta Photography Inc., also known as Nalaya Healing (“Nalaya”) and the undersigned (“Client”). The provision of personal photography services and/or coaching services by Nalaya to Client (“Sessions” / “Events” / “Ceremonies” / “Retreats” / “Activities” / “Offerings” / “Experiences" / "Meetings”, etc) are contingent upon this Agreement. This Agreement shall be effective on the signature date below.

Disclaimer from Nalaya to Client: You (Client) recognize and understand that my intentions are pure and by me holding space for you in our Session(s), I mean to honor and recognize your struggles as well as your gifts. I will hold space for you to work through whatever is manifesting for you, and I agree to meet you in truth, allowing space for healing and empowerment. Our Sessions are not professional mental health care or medical care.

Acknowledgements: In that spirit, by purchasing a Session(s) from Nalaya, you confirm that you have read and agreed to each statement, and that you wish to proceed:

1. I understand that Sessions are not a substitute for professional mental health care or medical care and are not intended to diagnose, treat or cure any mental health or medical conditions, and I will not use the Sessions in place of any form of therapy. I also understand that no one at Nalaya is acting as a mental health or medical professional.

2. I understand that Sessions are intended to be healing, freeing, honest, raw, uplifting, empowered, intuitive, meditative, strengthening, bonding, opening, supportive, loving, and sacred. I understand that Sessions are not in any way intended to be sexual, predatory, judgmental, or hateful. I acknowledge that Nalaya has informed me of the inherent risks of the Sessions and will recommend adjustments to my experience if deemed necessary.

3. I understand, if I elect to incorporate physical touch or massage as a part of my Sessions, that Nalaya does not provide professional massage services, and that all physical touch is in service of my greater journey of healing and empowerment.

4. I understand that all communications, writings, and ideas offered by Nalaya before, during, and after my Sessions are solely for the purpose of aiding me in achieving personal growth. I understand and agree that I am fully responsible for my well-being and choices before, during, and after my Sessions.

5. I have the ability to give my informed consent, and I hereby give such consent to Nalaya to assist me in achieving my goals with the understanding that results are not guaranteed.

I understand that, although my participation in this Event and the related activities is voluntary, I hereby agree to remain in the physical areas requested of me during the Event organized by Nalaya Healing. I further agree that I will not attempt to leave the Premises until the Event’s conclusion or I have communicated with an authorized representative of Nalaya Healing.

I understand I may be physically or mentally exhausted and/or disoriented after the Event, and that I must arrange to have time to process and integrate. I acknowledge that it is my responsibility to arrange alternate transportation, if needed, to leave the location of the Event at its conclusion or be required to stay as determined in the sole discretion of Nalaya Healing.

Assumption of Risk: I understand the dangers associated with physical activity and being in nature, including posing for photographs, participating in ceremony, or other activities at Events, Offerings, Meetings, Retreats, etc. I understand that these Sessions may take place outdoors and that the dangers which I may encounter at the site(s) where the Sessions take place (in each case, a “Site”) include, but are not limited to: wild animals, poisonous vegetation, falling tree branches, and rough terrain. I also understand that Sessions may evoke intense emotions, including but not limited to: trauma, guilt, pain, and fear, sadness. I realize that Nalaya cannot guarantee the availability of emergency psychological or medical services or emergency transportation to psychological or medical facilities. I agree that I am voluntarily participating in the aforementioned activities and assume all risks of physical or emotional injury, illness, damage, or loss to me or my property that might result. This includes, without limitation, injuries or damages arising out of the negligence of Nalaya, whether active or passive, or any of Nalaya’s affiliates, employees, agents, representatives, successors, and assigns, as well as any loss or theft of any personal property, whether arising out of the negligence of Nalaya or otherwise.

Release: I agree on behalf of myself (and all my representatives, heirs, executors, administrators, agents, and assigns) to release and discharge Nalaya (and Nalaya’s affiliates, related entities, employees, agents, representatives, successors, and assigns) from any and all liability, claims, and demands of whatever kind, including but not limited to physical or emotional injury, illness, loss of life, or damage to property, arising under law or equity, which arise from or are connected with my participation in the Session, whether caused by my own actions or the passive or active negligent actions or otherwise of Nalaya. I hereby knowingly and voluntarily assume any and all risks of any physical, financial, or other injury, damage, or losses, either to myself or caused to others or the Premises by me, during the Session. I agree to waive all rights to seek or receive compensation in case of injury, loss, or damage as a result of my participation in the Session and to compensate for any reasonable damages caused by me to others or the Premises. I further agree to defend and indemnify Nalaya Healing from any claims, suits, and/or demands.

Indemnification: By executing this Agreement, each party agrees to defend, indemnify, and hold harmless the other party (and its affiliates, related entities, employees, agents, representatives, successors, and assigns) against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including attorney fees, fees and the costs of enforcing any right to indemnification under this Agreement, and the cost of pursuing any insurance providers, incurred by an indemnified party in a final judgment, arising out or resulting from any claim of a third party related to the provision of Sessions by Nalaya to Client. I hereby agree that each and every provision of this Release is independent of any other provision and may be enforced even if other provisions are not enforceable.

I hereby certify that I am physically and emotionally able to participate in the Event, and I have no medical, physical, or psychological conditions that would endanger me or others in my participation in the Event. I also certify that I have disclosed ANY pre-existing medical conditions as simple as they may be.

I understand and acknowledge that it is for my own safety and the safety of others that I disclose all information requested of me on this Confidential Medical History Form and that I should identify use of any medications, whether contraindicated or not, to the authorized representative of Nalaya Healing. I hereby agree to complete the medical history form honestly and in full. I understand that use of prescription medications or illicit drugs two (2) weeks prior and subsequent to an Event may adversely affect my mental and physical health and will avoid such usage without first discussing it with an authorized representative of Nalaya Healing.

I understand that the Event in which I choose to participate may be physically, mentally, emotionally, and spiritually demanding. I understand that I may experience dizziness, nausea, or other physical upsets including vomiting and diarrhea. I accept all responsibility for anything that may occur including emotional disturbance, disorientation, and any and all possible manifestations of physical, emotional, and mental effects and changes. I acknowledge that the risks and potential benefits of my participation have been explained to me and I freely choose to enter this process accepting complete responsibility for whatever may occur, whether anticipated or unanticipated.

During the Event, I acknowledge that I will be ingesting and/or exposed to various substances prepared and/or provided by Nalaya Healing, such as eating food, drinking water and/or tea, and using other plants and herbs consistent with the intentions of the Event, such as drinking ancient medicines, smoking or inhaling the burning of herbs, incense, and firewood, etc. (individually or collectively referred to as the “Substances”. I acknowledge and understand that these Substances may have intended or unintentional effects on my consciousness that may result in non-ordinary and/or spiritual effects.

I understand and acknowledge that Nalaya Healing makes no claims regarding the curing of any illness or condition or about the nature of any spiritual experience. I understand that the experience during an Event is personal and that what may occur for one person may not be the same experience for another.Commitment to Self Care and Integration

I agree to arrive at ceremony prepared having followed Organizer and Guardian recommendations, and to plan in advance to make space in my life for integration after Ceremony. I understand that the experience can be overwhelming and difficult to immediately understand. It could have a destabilizing effect or call into question strongly held beliefs. I understand that additional personal work (rest, meditation, talk therapy, integration counseling, or similar) may be needed to appropriately integrate this experience into my daily life.

I agree to make no major life decisions for the period of 72 hours after the conclusion of the event.

I understand that accurate reporting of the above information is necessary to help ensure that I have a safe and beneficial experience. I realize that failure to provide accurate information may compromise my experience, and I have answered this questionnaire truthfully to the best of my ability. I assume full responsibility for my health and I understand that my participation in this activity may pose some risks. I hereby declare that I am not pregnant, I do not have any medical, physical, or psychological condition which would cause me any risk or harm or would be contraindicated for participating in this activity or otherwise endanger my health while participating in it, including but not limited to cardiovascular problems (history of heart attacks, cardiac insufficiency, malignant hypertension, arteriosclerosis, arterial aneurysm, or similar disorders), glaucoma, epilepsy or previous psychotic breaks. I also understand that this activity is not a replacement for medical or psychological care and may not be suitable for treating serious emotional, psychological disorders or spiritual emergencies. I assume the full responsibility to maintain the accuracy and contemporaneousness of my information in this form.

I am aware that this activity may be physically, emotionally and mentally stressful. I agree to assume full responsibility for my own physical, emotional and mental health. I indemnify and agree to hold Nalaya Healing and all authorized representatives of Nalaya Healing (hereinafter referred to as the “Guide”) harmless from any attributable physical, emotional and/or mental damage. I further indemnify and hold the Guide harmless from any and all loss, liability, injury, damage, or cost which may arise out of or in connection with my participation in this activity. In the event of a medical emergency, I give permission to contact emergency medical services and providers. I declare that I freely chose to undertake this activity and asked the Guide to accompany me to support me and monitor my safety. I understand that, if questioned by medical providers or the police, I will confirm that I asked the Guide to sit for me and will keep confidential the origin of any and all materials connected to the activity. I commit to monitoring my wellbeing and communicate with the Guide as needed, asking for appropriate support to optimize my experiences and reduce my risk.

I voluntarily assume full responsibility for any risk of loss, property damage or personal injury, including mental illness or death, that may be sustained by me, or any loss or damage to property owned by me because of being engaged in this activity whether caused by negligence or otherwise.

In consideration of being allowed to participate in this activity, I hereby agree not to sue and release, waive, discharge the Guide, organizers, hosts, participants and community from any and all liability, claims, demands, or course of action whatsoever arising out of, or related to any disorders that might develop during, after or as a direct or indirect result of participating in this activity, as well as any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me whether caused by the negligence of release, or otherwise, while participating in this activity, or while in, on or upon the premises where this activity is being conducted. I agree to indemnify and hold harmless those with whom I engage this work. I commit to keeping the Guide’s, organizers’, hosts’, participants’ and community’s names and contact information strictly confidential and will share any such information only after receiving unequivocal consent to do so by the relevant party(ies) involved.

I have duly reviewed this document and have had the opportunity to ask any questions regarding the activities this document covers and the content of this form and received satisfactory answers. I have understood the information provided. I am of a sound mind and body, participate voluntarily and understand that I am personally responsible for my experience. I waive, release and discharge any and all claims, rights and/or causes of action which I now have, or which may arise out of or in connection with participation in this activity, as well as which may arise out of or in connection with my attendance and/or participation in other activities associated with the Guide. Therefore, under no circumstance will I prosecute or present any claim for personal injury, property damage or any other cause of action against the guide. I acknowledge I am familiar with California Civil Code § 1542, which provides: A general release does not extend to claims which the creditor does not know or suspect to exist in their favor at the time of executing the release, which if known by them must have materially affected this settlement with the debtor. I hereby waive and relinquish any rights or benefits they may have under California Civil Code § 1542 with respect to any claims arising from, or related to the Guide or any of its activities. This document is binding on my heirs, assignees, dependents, personal representatives and estate. No oral representations, statements or inducements have been made to me to cause them to enter into this agreement.

At the choosing of the Guide any claim or controversy that arises out of or relates to this document, or the breach of it, may be settled by arbitration in accordance with the rules of the American Arbitration Association. Such arbitration shall be binding upon the parties and Judgment upon the award rendered may be entered in any court with jurisdiction.

Should the Guide be successful in bringing an action to enforce the terms hereof or successful in defending itself from a suit brought by me, my heirs or assigns, the Guide shall recover all costs and expenses incurred in such action, including reasonable attorneys’ fees.

Should any provision of this document be held invalid or illegal, such illegality shall not invalidate the remaining portions. In that event, this document shall be construed as if it did not contain the invalid or illegal part, and the rights and obligations of the parties shall be construed and enforced accordingly.

This release, waiver and indemnity of liability applies to all present and future work with the Guide.

I have read this document and understand it contains a release of all claims for injuries and damages. I voluntarily sign my name evidencing acceptance of the provisions of this agreement. If English is not my native language, I have either studied enough English to be able to read and understand this agreement, or I have had this agreement explained to me in my native language. By filling in the below field with any combination of characters and submitting a fully completed form I agree that I am digitally signing this Attachment.

Please reach out if you have any questions or comments.