General Application for Student Membership and participation in PSS1 & PSS2 program levels of the Mindfulness-Based Psychedelic Therapy Training Program of the Center for Medicinal Mindfulness.

Personal Information


Program Interest


Personal Support & Emergency Contact Information

You certify that your personal support and emergency contact knows about your interest in our program and agrees to be your friend/ally during the training, is generally available, and agrees to be contacted in case of an emergency.


Resume or CV

Our program attracts both young adults in college to advanced professionals. Please submit your resume or CV so we can get to know you more. As an optional exercise in professional development in the field of psychedelics, consider including professional psychedelic experiences and skills that you might not put on resumes for other jobs. As always, this information is kept strictly confidential. Please submit in PDF format.


Driver’s License or Other Identification

Please submit a copy of your driver’s license or other documentation to verify your age (must be 21 or older) and identity. This information will be kept strictly confidential.

For increased safety in the field of psychedelics, students in the Professional Track undergo a standard background check prior to credentialing.


Personal Essay

Please submit a personal essay so that we may get to know you and your background. Explore any of the following writing prompts (420 word maximum):

  1. Why do you feel called to become a psychedelic guide? Describe an experience, with a psychedelic or other significant moment, that has led you to seek out this program.
  2. How do you see yourself practicing these skills in your life? 
  3. What kind of unique contributions do you envision yourself making in the psychedelic field?
  4. Describe an aspect of your personality or background that you believe will help you succeed in being a psychedelic guide.
  5. Discuss the top three skills that you would like to develop to become a confident psychedelic guide.

Safety, Informed Consent, Community Guidelines, Training Agreements

Informed consent is very important in the field of psychedelic therapy. Due to the complex, holistic nature of our training program, the paperwork involved is quite extensive. Reviewing these documents is an epic journey in and of itself. Please read these documents and sign. They include important information about our program, as well as expectations for our students and community guidelines. These are required to participate in our online and in-person training programs.

Please pardon any overlap in the questions as some of these forms are used individually for other programs and services.


You will be filling out the following forms:

Informed Consent and Participation Agreements

  1. Psychedelic Safety Assessment
  2. Training Participation Agreement
  3. Psychedelic Cannabis Experience Participation Agreement
  4. Community Breathwork Participation Agreement
  5. Yoga Participation Agreement
  6. Covid-19 Safety - Only Required for In-Person Training Options

For additional information on our Covid-19 Safety Protocol visit this page. 

Community Guidelines

  1. Psychedelic Experience Agreement
  2. Community Guidelines for Online & In-Person Training Intensives & Practicums

Psychedelic Safety Assessment

v14 ©2012-2022


Please complete the Psychedelic Safety Assessment and provide additional information when requested. Due to the psychedelic experiential in the training program, we want to ensure that you can participate safely.

Please pardon any overlap in the questions as some of these forms are used individually for other programs and services.

Taking this assessment is required before participating in any psychedelic related events or services with the Center for Medicinal Mindfulness and Psychedelic Sitters School. The questionnaire could be used as a self-assessment, or may also be part of a structured psychedelic safety interview to participate in ongoing classes, psychedelic therapy, or our training program.  Please return before your scheduled session or interview and contact your facilitator with any questions.

A Few Notes About the Assessment:

Psychedelic experiences are very safe, but they are not for everyone. None of the questions, except the first one about pregnancy, will automatically disqualify you from participating in psychedelic events at the Center for Medicinal Mindfulness. This is an opportunity to discuss safety and help your facilitator create the necessary preparation and integration support so they can provide the safest and most appropriate container for your experience. Participation agreements and informed consent documents may also be required to participate in any psychedelic medicine programs with the Center for Medicinal Mindfulness. 

Although most experiences are positive and deeply meaningful, psychedelics often show us what we need to see, not what we always want to see. Therefore, being approved to participate in an experience does not guarantee an easy or enjoyable experience.

Contraindications (reasons not to participate in a psychedelic experience) are included in the specific service’s participation agreement and listed throughout these questions. With the right support, private individual sessions or small groups can be facilitated to treat significant clinical concerns that might not be as safe to engage in a large group setting, celebratory experiences, or the training program.

If you have ANY concerns whatsoever about your physical or mental health we have a doctor on staff who specializes in making this kind of assessment that you can speak to.  If you have any concerns about your mental health, and your capacity to participate in any event safely, we have licensed mental health practitioners that can support you in your decision making process as well. 

To members of BIPOC, LGBTQ, and other marginalized communities who experience trauma caused by generational systems of oppression, none of these questions are intended to exclude you because of the ongoing traumas of racism and other forms of discrimination that you commonly face. Comments are provided under some of the questions to provide additional context about why certain questions are asked.

If you have any questions regarding your personal safety, or this assessment, you can email us at safecommunity@medicinalmindfulness.org.

Again, our events are very safe, but they are not for everyone. Please be honest with yourself and us regarding your readiness for exploring psychedelic medicines. We are here to support you through this decision-making process. All information provided is confidential and stored in a HIPAA protected drive or secure filing system.

Contact Information

imported from first page of application


Name:
Age:
Email:
Phone number:

Emergency Contact Name:
Emergency Contact Phone #:
Emergency Contact Email:
Relationship to you:

 

Physical Safety


Psychological Safety


Psychedelic Safety


I certify that this information is accurate and complete. I understand that I can schedule appointments to speak to a medical doctor and/or a licensed mental health counselor about my Psychedelic Safety Assessment.  I understand that an additional safety evaluation is required for clinical services and events, and if I choose to participate in non-clinical, training, or celebratory events, I affirm that I am healthy enough to do so.

Sign Here

Name:

Training Participation Agreement

If you are flying into Colorado from a lower elevation, please drink plenty of water and electrolytes to stay hydrated when you are here. The most common symptom of dehydration is an annoying headache. Drink more water than you think you should.   

This document is a disclosure statement and participation agreement for those entering any interactive class in the Psychedelic Sitters School Training program, or for participating in our membership program.

***Important Disclaimer***

Psychedelic Sitters School is a professional training and membership program associated with the Center for Medicinal Mindfulness.  Acceptance into the training program or membership is not guaranteed.  All candidates will be assessed on an individual basis.  Only after registration requirements have been properly completed, will a final determination be made regarding your potential acceptance into the program.  As such, do not confirm any logistical/travel arrangements (e.g., requesting time away from work, purchasing airfare, etc.) until you have been contacted by us, in writing, of your formal acceptance into the program.  The Center for Medicinal Mindfulness, Psychedelic Sitters School, and/or any of their officers and/or owners cannot be held liable for any such incurred costs.

Program Information

By attending a training program, or applying for membership, you acknowledge you have read and understand all relevant program information on the www.psychedelicsittersschool.org website. This website is our program guide and is updated annually. Any substantial changes are included in an annual membership statement. 

Prices for the training or other requirements are subject to change over time, and will be disclosed on the website. Our intention is full disclosure and informed consent. You understand that you are invited to ask clarifying questions regarding our policies at any time. 

Designated Driver or Taxi Service Required if cannabis is consumed

If you drive yourself to a local event and consume cannabis, or do not have a designated driver, we will help you schedule a cab.  You will be unable to use cannabis at the event without a prearranged ride from this event.  Ridesharing:  www.uber.com & www.lyft.com  Local Taxi: www.zTrip.com (303) 699-8747 - Taxi service pick ups can be scheduled prior to the event.  Driving to and from a residential retreat is allowed only if cannabis is not consumed on the day of travel.  

Personal Safety - Cannabis Consumption is Optional 

Consuming cannabis during the journeywork practicums at a Psychedelic Sitters School online or in person training intensive is recommended but not required. You agree to only consume cannabis if it is safe for you to do so, that you are in a private location, and agree to not drive for the remainder of the day. We can only recommend attending our program if you can legally use cannabis, either through obtaining a medical card, or where cannabis is legal for adult consumption. Where cannabis is not legal, we offer the training as an education and psychedelic harm reduction program. To participate, you agree to take full responsibility for your own safety, legality, and personal employment requirements.  

Participation in Online Community Groups and Forums

Participating in the community forum is strongly encouraged. This is a professional training community and all communications should be professional in nature. You are required to use your real/preferred first name and last initial for your profile name. Professional facilitator members are invited to share their full last name. By participating in the forum, you agree to be respectful, factual, and kind in your communication, and to keep conversations and identities confidential. You are only allowed to share your private contact information with those you trust, and to share only what you are comfortable with sharing. You are never required to provide your private contact information with other community members outside the leadership team to participate in any of our programs. Under no circumstances are you allowed to provide information on how to obtain illegal medicines, or information on underground practitioners.  

Payment & Refund Policy

Online lectures require full payment to access and are non-refundable. For live (online) and in person classes, half of the total tuition payment is required to reserve your spot in a training or retreat, with the second half of the payment due one month before the first day of class. 

All payments are non-refundable, however, students can change the date of a training intensive with one month notice.  We will work with you however we can to support you in this process. Payment plans are also available. 

Before paying the first half of the tuition as the deposit, you are required to confirm that the dates work on your end, and that you have all of your questions answered regarding safety and the participation agreements.  Due to the substantial services provided to students once they register for a training, and the logistics required to facilitate these events, once you commit, we want you to commit, as we are committing the same to you. 

Although no refunds will be issued after a payment is received, until we are through this global pandemic, we can transfer reservations for in-person intensive retreat dates for those who cannot attend last minute due to Covid-19 guidelines or other significant safety concerns. Online participation options are available for most programs. In the unlikely situation an in-person training intensive is cancelled due to Covid-19 or other significant regional safety concern, students agree to automatically transfer to an all online training option during the same time period if offered. 

All trainings are offered “as is” and no requests for credits, refunds or partial refunds will be accepted after a service or training is initiated or provided. While we are extremely confident in both the psychedelic nature and reliability of cannabis to induce very real psychedelic experiences, as well as the quality of our program, not everyone has the experience they expect. By being a student of this program, you agree to seek guidance in the unlikely chance that your psychedelic experiences are not as “psychedelic” as expected. Because cannabis is so reliable as a very potent psychedelic in this context, the program is designed to support troubleshooting common questions regarding the quality and intensity of these experiences. 

You agree that you have read and accepted this policy, and that MM will not accept any chargebacks or other forced credit card refunds in violation of this policy. To request a transfer of services or credit in accordance with our policy, please email training@medicinalmindfulness.org.

Certificates of Completion and Credentialing

Students that complete a training will receive certificates of completion as partial completion of our credentialing program.  Information on the PSS credentialing program is available here: 

https://psychedelicsittersschool.org/credentialing/ 

Registration & Application Information

Information on the PSS application process is available here:

https://psychedelicsittersschool.org/apply/ 

To ensure your safety and readiness to participate in our program, an interview process is required. Sometimes we also require additional information or a second interview after we review your application. This follow up interview is free.

Due to the intensive nature of our program, we do our best to keep the requirements as outlined on our website. However, we reserve the right to recommend or require additional support or practices to participate in our program that may require additional personal expense. We will discuss additional requirements with you and why we think they’re needed for your ongoing success as a psychedelic guide and keep the cost as reasonable as possible. 

Training Participation Agreement

The Center for Medicinal Mindfulness and Psychedelic Sitters School are committed to making safe and skillful journeywork and guidework practices as accessible as possible.  Becoming skillful in our journeying, sitting, and guiding techniques takes time and a lot of practice.  In addition to this, because of the spiritual or transpersonal nature of our work, we are all required to go through our own healing and awakening process, often in ways we didn’t know before we began.  These can be big experiences for our students and members.

Psychedelic Sitters School is committed to supporting our students in reaching the highest level of training and skill that they wish to reach.  This takes time. By participating in this program, you agree to be intentional with your process and to not place yourself in situations that are above your ability, training and experience.  Knowing your limitations and your gifts takes a little time.  Facilitating your own groups or individual experiences without the right support can cause harm to yourself and others. 

You also agree to seek mentorship and support when necessary, especially during difficult transformational experiences. Sometimes these moments can be 

Personal Responsibility for Guides and Sitters in Training

Medicinal Mindfulness is a Psychedelic Harm Reduction & Education Program, and a training program for individuals interested in becoming psychedelic sitters, therapists, guides, and group psychedelic facilitators.  This is a developing profession and there are currently no uniform legal, ethical or professional practice standards in our society. While Medicinal Mindfulness only works with legal medicines and breathwork practices, some individuals take our trainings and integrate what they learn into already established psychedelic therapy practices with other substances. 

Due to the complex nature of this work, and the vast array of how these skill sets can be used, Medicinal Mindfulness is unable to regulate individual use practices that are outside the scope of our training program. Therefore, those who are currently practicing as guides, sitters, and transpersonal facilitators in psychedelic contexts are fully responsible for the outcome of their actions.  Medicinal Mindfulness reserves the right to not work with students or potential students whose actions are not in alignment with our definitions of safe use practices.

To support the development of important ethical and safety standards for the use of psychedelic medicines in spiritual, clinical, and community use settings, and to have an ongoing dialogue about medicine use that is safe from harassment and abuse, the Center for Medicinal Mindfulness, Psychedelic Sitters School, our Non-Profit, and the Extended-State DMT Program, and our representatives, fully comply with all applicable, local, state, and federal laws, and adheres to the principles in the following documents:

Learning how to work professionally as a guide and to engage community ethically takes time. Participants agree that these standards will be our guide when exploring ethical considerations in accordance with our MM Safe Community Policy (updated annually). 

Students, members and trainees of Medicinal Mindfulness agree that they cannot represent Medicinal Mindfulness in any context, specifically in media related interviews and presentations, without the expressed written permission of Medicinal Mindfulness.  Medicinal Mindfulness owns certain trade names in our work and marketing to denote a differentiation in our services from other services.  Students agree that these trademarked names, as well as the Intellectual Property of our training program, cannot be used by students in practice or to train others, without permission from the program through our credentialing program and a required service agreement.

Notice of Non-Discrimination and Prohibition of Harassment

By participating in Psychedelic Sitters School, I agree to with the MM Notice of Non-Discrimination and Prohibition of Harassment:  Committed to equality of transformational opportunity, the Center for Medicinal Mindfulness does not discriminate in offering access to its programs and activities, or employment on the basis of race, color, gender, age, national or ethnic origin, religion, disability, veteran’s status, sexual orientation, gender identity, or gender expression, responsible psychedelic medicine use (as defined in the MM Safe Community Policy), or any other status protected by law. 

Assumption of Risk

In consideration of the services of  the Center for Medicinal Mindfulness, Psychedelic Sitters School, and affiliates: Daniel McQueen and all training associates, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as MM), I hereby agree to release and discharge MM, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:

Emotional Risk:

  1. I acknowledge that I understand this is a professional training, which includes self-reflection, interactive exercises, time outdoors, and professional growth. I acknowledge that I have a choice about the level of my participation at all times and that, although personal material may arise for me within the context of the training, this is not therapy, and I am responsible for my own well-being. If I feel the need arises for therapy, I will take action accordingly or request the appropriate resources. 
  2. I am aware that participants are asked to hold confidentiality of personal material disclosed in the training, but this cannot be guaranteed.
  3. I understand that an MM training is intended as a personal growth experience and should not be used as a substitute for psychotherapy or medical treatment.
  4. I understand that a MM training could involve dramatic experiences accompanied by strong emotional and physical release as outlined in the Psychedelic Cannabis Participation Agreement.

Physical Risk:

  1. I have read the Psychedelic Cannabis Participation Agreement and the Community Breathwork Agreement, and the Yoga Agreement, and I acknowledge the inherent risks in participating.  
  2. I certify that I have adequate health insurance to cover any injury or damage I may suffer while participating, or else I agree to bear the costs of such injury or damage myself.  I further certify that I am willing to assume the risk of any medical or physical condition I may have.

General:

  1. I understand that the use of cannabis is completely optional and that I agree to only use cannabis in designated areas, and only when it is safe to do so.
  2. I understand that the use or possession of illicit substances and alcohol before, during, after or around the training is explicitly forbidden and that I will be immediately asked to leave the training program if I bring, use, or offer illicit substances to other students.  
  3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless MM from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of MM's equipment or facilities, including any such claims which allege negligent acts or omissions of MM
  4. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against MM on the basis of any claim from which I have released them herein.

Psychedelic Safety Assessment 

I agree to read and answer the Psychedelic Safety Assessment before my interview with a Medicinal Mindfulness facilitator.  While cannabis is legal in Colorado to possess and consume in certain contexts, and is used recreationally and safely by millions of people, I understand that psychedelic cannabis experiences are transformational experiences that are more akin to meditation retreats and other entheogenic practices.  By signing this form and by attending Psychedelic Sitters School, I certify that that I am physically, mentally, emotionally and spiritually fit enough to safely participate.  I also acknowledge that I can speak with a Medicinal Mindfulness facilitator about any safety concerns before attending the training. 

In case of emergency, I understand that effort will be made to secure proper treatment. I hereby give permission for such treatment. My personal health and accident insurance covers any accident or illness that I may incur during this experience and I will personally guarantee any cost or other liability incurred during evacuation or treatment. I have read the description of the program and information provided for preparation and understand the nature of the program and risks involved.

ADDITIONAL PROVISIONS

This Agreement shall be governed by the laws of the State of Colorado.  MM in its sole discretion may demand that any disputes arising between the parties relating this Agreement, including but not limited to refunds, will be submitted to and settled by binding arbitration under and pursuant to the Colorado Uniform Arbitration Act and that any decision or award of the arbitrator will be final and binding upon the parties enforceable in any court of competent jurisdiction.  If a party brings an action to enforce the provisions of this Agreement, then the substantially prevailing party will be entitled to recover its reasonable attorneys’ fees and expenses incurred in such action from the non-prevailing Party.

Informed Consent

I have read this document and understand the requirements for being a student of Psychedelic Sitters School and agree to comply with these expectations.

Sign Here

Name:

Email Address:

Psychedelic Cannabis Experience Participation Agreement

Cannabis is legal to possess and use in certain contexts in Colorado, but the laws are complex and rapidly evolving. This agreement ensures that you, the facilitators and MMClinic LLC &  MMTraining LLC, collectively known as the Center for Medicinal Mindfulness (“CMM”) are properly and legally protected. 

This agreement only needs to be read and signed before your first experience and once per calendar year to participate in any Psychedelic Cannabis Event or Conscious Cannabis Event (collectively “CCE”) we facilitate unless a new regulation affects how we provide our services. 

IMPORTANT NOTE: The Psychedelic Cannabis Event Participation Agreement is for non-clinical events only. Cannabis is legal in Colorado for adult use without a recommendation from a Medical Doctor. This agreement has been used since 2014 for participants in adult use, celebratory, training, growth oriented workshops, and spiritual group experiences called Conscious Cannabis Circles, Cannabis Healing Meditations, Psychedelic Sitters School, and other events. For psychedelic cannabis experiences that are offered in conjunction with clinical support, the Center for Medicinal Mindfulness requires participants to read and sign the Cannabis-Assisted Psychedelic Therapy Informed Consent Agreement and participate in additional support requirements, and a safety evaluation by both a mental health professional and our Medical Director. This document is for growth oriented, non-clinical events only. 

If you have ANY concerns whatsoever about your physical or mental health we have a doctor on staff who specializes in making this kind of assessment that you can speak to.  If you have any concerns about your mental health, and your capacity to participate in any event safely, we have licensed mental health practitioners that can support you in your decision making process as well.  

By signing this you acknowledge that any medical or mental health assessments you may need have been made available to you to assess any physical or mental health concerns, and you hereby relinquish the Center for Medicinal Mindfulness, related programs and facilitators, of any harm caused to you as outlined herein. Your presence at a CCE event and decision to use cannabis during the event is strictly voluntary and does not constitute a medical recommendation by the Center for Medicinal Mindfulness or its facilitators for the use of cannabis as a therapeutic option.

Cannabis, Mental Health, and Cannabis Law

Psychedelic Cannabis Experiences are safe, but they are not for everyone. 

While there is a growing body of medical and anecdotal evidence that supports the skillful and intentional use of cannabis for personal growth, those under medical supervision or people with a history of mental health disorders should consult their medical doctor before participating in a CCE.  Unstable interpersonal relationships and people with a history of psychiatric treatment are additional factors which make it difficult for people to receive benefit from a CCE. 

Our capacity as a small consciousness community makes it impossible for us to properly care for people with significant psychiatric or physical health concerns in the context of a group CCE.  Although CCEs can be beneficial and very safe for almost all participants, these events are not a substitute for medical or psychiatric treatment and we do not recommend it for people with serious psychiatric disorders or physical conditions that may impair their ability to participate safely.  

Contraindications (reasons not to attend) include, but are not limited to, pregnancy and physical health problems, clinically significant acute anxiety or other mood disorders, psychosis, bipolar disorders, personality disorders, acute trauma and PTSD, acute addictions, suicidal ideation/self harm and tendencies for disruptive behavior.

A CCE is not appropriate for persons with cardiovascular problems, severe hypertension, severe mental illness, recent surgery or fractures, acute infectious illness, or epilepsy. 

Finally, and while Colorado has passed laws allowing for the creation of marijuana hospitality and sales establishments, the Center for Medicinal Mindfulness is not licensed to provide cannabis to participants and all cannabis consumed during an event must be brought by the participant.  

Thank you for attending a Conscious Cannabis Event of the Center for Medicinal Mindfulness.  

Basic Membership Requirement

I agree to become a member of the Center for Medicinal Mindfulness.  There are no fees or other requirements - this simply gives everyone an additional level of legal protection and is one factor that makes CCEs invitation only and private events.

Designated Driver Required

PLEASE NOTE:  If you drive yourself to the event or do not have a designated driver, we will help you schedule a cab.  You will be unable to use cannabis at the event without a pre-arranged ride from this event.  Ridesharing:  www.uber.com & www.lyft.com  Local Taxi: www.zTrip.com (303)699-8747 - Taxi service pick-ups can be scheduled prior to event.

I will not drive myself home from any CCE event that I consume cannabis at, nor drive again before completely sober.

Safety Assessment

I have reviewed the Psychedelic Safety Assessment. By signing this form and by attending the Conscious Cannabis Event, I certify that that I am physically, mentally, emotionally and spiritually fit enough to safely participate in this event.  I also acknowledge that I can speak with a Center for Medicinal Mindfulness facilitator about any safety concerns before attending the CCE.  Individual Safety Interviews by a Medicinal Mindfulness Facilitator are also available.  

Informed Consent

I understand that a CCE is intended as a personal growth experience and should not be used as a substitute for psychotherapy or medical treatment.

I understand that a CCE could involve dramatic experiences accompanied by strong emotional and physical release as outlined in the CCE Participation Agreement. 

Substance Use Policy

I understand that the use or possession of controlled substances other than Cannabis sativa L. is expressly forbidden before, during and after a Conscious Cannabis Experience.

Psychedelic Cannabis Event Participation Agreement

This is a legally binding agreement (“Agreement”) between you and the Center for Medicinal Mindfulness (collectively “CMM” or “us”) governing your participation in any Conscious Cannabis Event (“CCE”), such as a Conscious Cannabis Circle, Cannabis Healing Meditation, Individual Cannabis Journey, Cannabis Breathwork Event, and/or any other event facilitated by CMM (“Event(s)”) during the 2021-2022 calendar years. Please read the terms of this Agreement carefully. You must read, agree to and sign this Agreement before participating in any Conscious Cannabis Event facilitated by CMM. Do not sign this agreement if you do not agree or do not understand its terms written below. The facilitator(s) for these Events may be Daniel McQueen, MA, or any other sitters, organizers or facilitators of CMM (“Facilitator(s)”). 

CMM and the Facilitator(s) reserve the right to decline any individual interested in participating in any Event at any time and for any reason CMM and the Facilitator(s) may deem appropriate.

1.  Purpose. Conscious Cannabis Events combine somatic, alchemical, shamanic, meditation and personal growth paradigms to create a holistic, transformative and skill building experience for each participant through a facilitated, mindful group experience using music, ceremony, intention and the optional use of cannabis. CCEs are designed to reduce potential for harm caused by cannabis use through education and experientials in intentional and transformational use. Our harm reduction and education paradigm provides a safe and joyful container for a community of individuals to explore profoundly healing and transformational inner states in a safe setting. This Agreement sets out boundaries and rules designed to maximize, as much as possible in this context, the safety and comfort of all participants in these Events. Due to the inherent risks of cannabis use, CMM and Facilitator(s) agree to organize and facilitate these Events only if they are legally protected from the inherent risks associated with your voluntary participation in these Events. This Agreement provides those protections. It is written to cover your participation in any CCE during the current calendar years denoted and only needs to be signed once during that period.

2.  Private, Invitation/Member Only. All CMM Events are private, and invitation-only events and are intended to comply with all applicable Colorado State laws. You must be a member of CMM to participate in any CCE. There is no fee for basic membership.

3.  Optional Use of Cannabis. The Events will present an opportunity for the optional use cannabis as part of the Event in furtherance of the purpose described in Section 1. Cannabis use is not a required part of any Event, nor will any cannabis be sold or provided by CMM or Facilitator(s).  CMM follows a strict “bring-your-own-cannabis” policy at all its Events.  It is a personal decision entirely at your own discretion, and at your own risk, as to whether and how much cannabis you will use as part of these Events. These Events are designed to enhance your ability to work with inner spaces in a more skillful manner, regardless of cannabis use.

1.  Laws Regarding Cannabis Use and Possession. You understand that the use and possession of cannabis remains illegal under federal law, and that your employer may make decisions based on your use or possession of cannabis. As of the date of this Agreement, the state of Colorado has passed recreational cannabis laws that allow possession and use of cannabis in certain circumstances. You understand and agree that if you choose to use cannabis in connection with these Events, you alone bear the entire responsibility for any outcomes resulting from such use, including possible discharge from employment. You agree that you will inform yourself about all applicable laws and regulations before making the decision to use cannabis as part of these Events, and that your use of cannabis, if any, as part of these Events will be in compliance with all applicable laws. You understand that no one is required to use cannabis in connection with these Events.

2.  Use at Your Own Risk; No Driving Under the Influence. You agree that if you decide to use cannabis as part of these Events, you do so entirely at your own risk and that neither CMM nor the Facilitators are responsible for any effect cannabis has on you or anything you do as a result of using cannabis or any other CMM activities. You agree that if you do decide to use cannabis at any Event, you will arrange for a sober, reliable individual to drive you home from the Event and that you will not drive until the next day. If the CCE is hosted in your own home, you agree not to drive until the next day. You agree that you will not drive to or from any Event under the influence of cannabis, other medicines, street drugs or alcohol. 

3.  Other Substances. You agree that you will not use any other medicines, controlled substances, street drugs or alcohol before, during or immediately following an Event.

4.  Cannabis Sativa Is Not Provided. CMM does not provide or sell cannabis for any aspect of our Events, and it is not a retailer, supplier, reseller, distributor, agent, representative or subcontractor of any cannabis supplier or retailer. Any decision by you or another CMM participant to purchase or accept such products from a vendor or individual outside of our program is a decision made at your sole discretion. CMM does not provide supply, retail, or distribute cannabis or act in any manner as a cannabis vendor or retailer. CMM disclaims all responsibility or liability for any sale of cannabis voluntarily provided to you by any vendor or dispensary.

4.  Full Personal Responsibility and Inherent Risk. All CCEs are voluntary adventures through inner space, and like any adventure, carries some risks that are impossible to predict for each individual. You agree to take full responsibility for your participation in these Events and all outcomes resulting from such participation. You agree to ask for additional support as needed from CMM and the Facilitator(s). You accept the inherent risks of these Events and acknowledge that your interest in this type of adventure and your desire for experiences beyond the normal safety and comfort of your ordinary day-to-day experiences is in part the reason for your participation in these Events. These risks may include, but are not limited to:

1.  Intense prana, energy, or somatic experiences, intense transpersonal experiences, life changing realizations, greater access to significant memories, apparent encounters with “archetypes,” “entities,” “ancestors,” “totems,” “guides” and “spirits,” physical and psychological experiences such as fainting, vomiting, extreme emotional states, panic and anxiety, unusual thoughts, and/or hallucinations.

2.  Physical harm from slips and falls while moving around under the influence of cannabis. During winter months, the outdoor areas at CMM locations may be icy or slippery, and you agree to use extra caution walking around these areas, particularly if you have consumed cannabis.

3.   Food Allergies - At the end of the CEE snacks are provided to participants that usually includes orange juice, chocolate (sometimes with nuts), gluten free pretzels, and strawberries or grapes. You are responsible of informing the facilitator(s) of any severe food allergies before the experience begins, and to take responsibility for any snacks you consume. 

4.  Negative experiences are uncommon, and are generally mild to moderately difficult. If a crisis requires additional emergency support by medical or mental health professionals, you agree to pay for all additional expenses of the intervention. CMM and Facilitator(s) have the right to call emergency support services if CMM or any facilitator determines that a crisis requires additional professional intervention. Emergency support services, and/or emergency contact will be contacted at the request of any participant.

5.  You agree that a safety questionnaire, phone conversation or brief interview may be required for your participation regarding some of these risks and your history of cannabis use. You understand that this interview is not a clinical assessment and does not guarantee an experience without these risks.

5.   Safety and Prerequisites. You affirm that you are in a good position to participate in these Events, meaning that you are psychologically, physically, spiritually and financially capable of participating. You understand that neither CMM nor the Facilitator(s) are in a position to determine whether participation in these Events or use of cannabis is appropriate or safe for you, and that you will only decide to do so after appropriate independent investigation, reflection and consultation with a licensed medical or health care professional.

1.   Representations. You represent and warrant each of the following:

1.  You represent and warrant that you have done the appropriate independent investigation to understand how cannabis use may affect your psychological and physical health, including consulting with your trusted health professionals if appropriate. You are informed as to how cannabis use may impact any psychological or physical conditions you may have, as well as how cannabis use may interact with any over the counter or prescription medications, herbs or supplements you are using. You understand that neither CMM nor the Facilitator(s) are responsible for how cannabis may affect you or anyone else should you decide to use cannabis as part of these Events

2.  You represent and warrant that you are not aware of any psychological or physical condition that would make it unwise for you to participate in these Events or use cannabis in the context of these Events. You represent and warrant that you have never been told to abstain from such practices or from cannabis use by any licensed medical or health care professional.

3.  You represent and warrant that you are not currently pregnant.

4.  You represent and warrant that you are at least 21 years of age or older as of the Date of this Agreement.

5.  You represent and warrant that you will completely and truthfully answer any and all questions in a safety questionnaire provided to you prior to any Medicinal Mindfulness Event.

6.  You agree to notify the Facilitator(s) immediately if any of the representations you make in this Section 5.1 change during the 2021-2022 calendar years.

7.  You represent and warrant that you are a member of the Center for Medicinal Mindfulness before participating in a Conscious Cannabis event.

2.  Non-sexual Touch. You understand that there may be strictly non-sexual physical touch for safety, calming or reassurance purposes during intense experiences by the Facilitator(s) from time to time. If you do NOT want to be touched in any way, except in the event of a true emergency for safety purposes, it is your responsibility to let the Facilitator(s) know prior to the start of the Event.  Touch will only be provided if requested or only after verbal permission, except in emergency situations requiring intervention.  

3.  Confidentiality. Although CMM and the Facilitator(s) will do our best to keep information you disclose during the Event confidential, because of the community nature of some CCEs, taking part in an Event may entail the unlikely risk of loss of confidentiality of sensitive information. CMM and Facilitator(s) reserve the right to discuss or write about individuals’ experiences during these Events for educational purposes without revealing any personally identifying information about the individual.

4.  Non-therapeutic Relationship. These Events are not designed to treat any person for any physical or mental condition or illness. CMM and the Facilitator(s) are not practicing medicine, diagnosing, curing, or treating disease or illnesses or recommending, administering or prescribing cannabis, prescription drugs or controlled substances in these Events. You understand that the Facilitator(s), although having clinical experience and training, are not your therapist, counselor or psychotherapist, but rather are technical facilitators for these Events. You understand that some experiential teachings in these Events may have therapeutic-like components but participating in any experiential is completely optional and for educational purposes only.

6.   Full Participation and Attendance. Because of the transformational nature and community aspect of these Events, please arrive up to 30 minutes early (15 minutes early is recommended) from advertised start time, as THERE WILL BE NO LATE ADMITTANCE TO ANY EVENT. Individual sessions will be billed at agreed upon start and end times, not duration, and will end on time. If you are not able to attend an Event in which you reserved a space in, due to illness or emergency, please contact your Facilitator as soon as possible to relinquish your space. You agree to participate in the Event in accordance with this Agreement and to not engage in any disruptive behavior. If at CMM's or the Facilitator(s)' sole discretion, you are found to be disruptive at an Event, you will be asked to leave. No refunds will be issued for an Event from which you are removed for disruptive behavior. Disruptive behavior is any behavior that threatens the safety or security of the community and includes drug use, inappropriate verbal or physical exchanges, and other behavioral problems as determined in the sole discretion of CMM and its Facilitators. Disruptive behavior does not include energetic discharges that have verbal or physical symptoms that happen during the Event, or any big experience, awakening or unintended crisis that happens during the Event that may require a Facilitator(s) intervention.

7.   Registration & Cost.   Pre-registration is required to ensure attendance. The total cost of the Event is provided in the registration information for the specific Event or invoice for individual Event and is due in full when registering. Payment can be made with cash or credit cards. “MMTraining LLC” or “MMClinic LLC" will appear on your credit card statement. 

Cancellation and Refunds.  Due to limited space, we require that you cancel at least 48 hours before a scheduled CCE. This gives us the opportunity to fill the event.  If you have to cancel your class after 48 hours, we offer you a credit to your account, but we do not offer refunds.  You may use these credits towards any future class.  However, if you do not cancel prior to the 48 hours, you will lose the payment for the class.  MM has the only right to be flexible here.  Cancellations made 48 hours or more in advance of the event date, will receive a 100% refund.  Additionally, MM will not accept any chargebacks or other forced credit card refunds in violation of this policy.

To request a refund in accordance with our policy, please email clinic@medicinalmindfulness.org.  Please review our service and event specific refund policy at www.medicinalmindfulness.org/refunds

8.   Photography. If photographs, videos or film are taken by CMM or the Facilitator(s) during an Event, we will disclose the purpose of the filming, and you will not be featured unless you give expressed written consent.

9.   Intellectual Property. All materials and content provided or streamed as part of the Event or in connection with the Event including but not limited to music, audio, sounds, video, photos, graphics, text and information (“Event Materials”), is proprietary material belonging to CMM, the Facilitator(s) or third parties, and may be protected by copyrights, patents, trademarks, trade secrets or other proprietary rights. You will not use, copy or distribute Event Materials without CMM’s prior written permission.

10. DISCLAIMERS OF WARRANTIES.

1.  You expressly understand and agree that the Event, and your participation in the Event or any Event-related occurrence, is at your own risk. Each Event and all Event Materials, are provided “AS IS” and without warranties of any kind, either express or implied. CMM and the Facilitator(s) disclaim all warranties related to any Event, and all Event Materials, express or implied, including but not limited to implied warranties of merchantability, fitness for a particular purpose, title, compatibility, security, accuracy, non-infringement, and any warranties implied by any course of performance or usage of trade.

2.  You expressly understand and agree that neither CMM nor the Facilitator(s) warrant or make any representations or guarantees regarding the outcome, experience or effect on you of participation in the Event or any Event-related occurrence. You expressly understand and agree that neither CMM nor the Facilitator(s) warrant or make any representations regarding the effects of the use of cannabis generally, the use of any strain or blend of cannabis particularly, or the use of cannabis specifically by you or other individuals.

11. Indemnification. You agree to indemnify, hold harmless and defend CMM, the Facilitator(s), and each of their agents, contractors, affiliates, representatives, and partners from and against any and all losses, damages, reasonable costs (including reasonable attorneys’ fees and expenses), liabilities or expenses arising from: (a) your participation in the Event or Event-related occurrences, (b) your violation of this Agreement, including a breach of any of your representations and warranties in this Agreement, (c) any physical or psychological harm, outcomes or effects resulting from your participation in an Event or your cannabis use, or actions you may take as a result of the Event or using cannabis, and (d) any other matter in relation to Medicinal Mindfulness and related Events, Event Materials or this Agreement. CMM and the Facilitator(s) reserve the right to assume sole control of any matter otherwise subject to indemnification by you under this Section 11. You agree in such circumstances to assist and cooperate fully with CMM and the Facilitator(s) in asserting any available defenses at your expense. You and/or your estate hereby indemnifies CMM and the Facilitator(s) against any claim by any person arising directly or indirectly from your death, injury, loss or damage suffered by you, allegedly caused or contributed to by an act or omission of CMM, the Facilitator(s) and each of their directors, officers, employees, agents, representatives, contractors, consultants and agents.

12. Limitation of Liability.

1.  YOU ARE VOLUNTARILY PARTICIPATING IN A MEDICINAL MINDFULNESS EVENT WITH KNOWLEDGE OF THE RISKS THAT MAY BE INVOLVED AND YOU HEREBY AGREE TO BE RESPONSIBLE FOR YOUR OWN HEALTH AND WELFARE AND ASSUME ALL RISKS OF EMOTIONAL DISCOMFORT OR TRAUMA, PERSONAL INJURY OR DEATH. You acknowledge and agree that neither CMM nor the Facilitator(s) are responsible for and have no duty to take action regarding: (a) your participation in and the effect of the Event or any Event-related occurrence on you, (b) your personal decision to use or possess cannabis and how much, if any, you decide to use as part of the Event, (c) any effects of cannabis use or possession, including physical, psychological, legal or employment outcomes, (d) any physical or psychological harm or personal injury resulting from your participation in an Event or your cannabis use, or (e) any outcomes or actions you take as a result of having been exposed to the Event, or possessing or using cannabis. You hereby release CMM and the Facilitator(s) of any and all liability arising out of your participation in the Event and any Event-related occurrence, and your accessing any Event Materials. You hereby release CMM and the Facilitator(s) of any and all liability for your possession or use of cannabis should you decide to possess or use cannabis.

2.   You acknowledge and agree that, to the maximum extent allowed by law, CMM, the Facilitator(s), and each of their agents, contractors, affiliates, representatives, and partners shall not be liable to you, or any third person as a result of your violation of this Agreement, under contract, tort, strict liability, negligence or any other legal or equitable theory for any direct, indirect, incidental, special, consequential, exemplary or punitive damages, or any other damages whatsoever, including but not limited to, damages for loss of profits, goodwill, use, data or other intangible losses (even if CMM or the Facilitator(s) have been advised of the possibility of such damages), arising out of, or resulting from: (a) your participation in a Medicinal Mindfulness Event, your use of Event Materials, or your cannabis use, or actions you may take as a result of the Event or using cannabis, (b) access or inability to access any Event or Event Materials; (c) use or misuse of cannabis or any other substance (illegal or legal) during, preceding or following any Event, or Event-related occurrence; (d) unauthorized access to or alteration of transmissions or data; (e) violation of this Agreement; (f) infringement of any intellectual property or other right of any person or entity; (g) for breach of any representations and warranties in this Agreement; and (h) any other matter relating to the Event, Event-related occurrences or Event Materials.

3.   You expressly agree that in no circumstances shall the collective liability of CMM, the Facilitator(s) and each of their agents, contractors, affiliates, and representatives for all damages, losses, and causes of action (whether in contract, tort (including, but not limited to, negligence) or otherwise) exceed the total amount paid to CMM by you under this Agreement for the specific Event during which such losses occurred. Certain states do not allow the exclusion or limitation of incidental or consequential damages, so some of the above limitations and exclusions may not apply to you.

4.   You expressly understand and agree that under no circumstances will CMM, the Facilitator(s), or their agents, contractors, affiliates, representatives, and partners be responsible for any loss or damage, including personal injury or death, resulting from your participation in the Event.

13. YOU AND CMM ACKNOWLEDGE AND UNDERSTAND THAT THE DISCLAIMERS, EXCLUSIONS AND LIMITATIONS OF LIABILITY SET FORTH IN SECTIONS 10, 11 AND 12 FORM AN ESSENTIAL BASIS OF THE AGREEMENT, AND THAT WITHOUT DISCLAIMERS, EXCLUSIONS AND LIMITATIONS OF LIABILITY, CMM WOULD NOT ENTER INTO THIS AGREEMENT WITH YOU.

14. Entire Agreement. This Agreement, together with the Registration Form and any safety questionnaire provided to you by CMM, constitutes the entire Agreement between you and CMM and the Facilitator(s) with respect to any Event in 2020-2021, and supersedes any and all prior or contemporaneous oral or written discussions or agreements between the you and CMM and the Facilitators.

15. Governing Law; Venue. You, CMM and the Facilitator(s) agree that any dispute or controversy arising under or relating to this Agreement or any Event shall be governed by and construed in accordance with the laws of the State of Colorado excluding its conflict of law rules. You agree that any cause of action arising out of or related to this Agreement must commence within one (1) year after the cause of action arose; otherwise, such cause of action is permanently barred. You irrevocably consent to the exclusive personal jurisdiction of the Colorado State Court located in Boulder, Colorado for any suit or action arising from or related to this Agreement, and waive any right you may have to object to the venue of such courts.

16. ARBITRATION.   MM in its sole discretion may demand that any disputes arising between the parties relating this Agreement, including but not limited to refunds, will be submitted to and settled by binding arbitration under and pursuant to the Colorado Uniform Arbitration Act and that any decision or award of the arbitrator will be final and binding upon the parties enforceable in any court of competent jurisdiction.  If a party brings an action to enforce the provisions of this Agreement, then the substantially prevailing party will be entitled to recover its reasonable attorneys’ fees and expenses incurred in such action from the non-prevailing Party.

17. Other Terms.

1.   Sever-ability. If any of these terms is found to be for any reason unenforceable, then that term shall be limited or eliminated to the minimum extent necessary so that the Agreement will otherwise remain in full force and effect and enforceable.

2.   Survival. Any section that by its nature should survive expiration or termination of this Agreement shall remain in effect after the expiration or termination of this Agreement, including but not limited to, Sections 4, 5, 7, 9, 10, 11, 12, 13, 14, 15, and 16.

3.   No Assignment. This Agreement is personal to you and you may not assign or transfer it to anyone else. CMM may assign, transfer or delegate any of its rights and obligations under this Agreement without your consent.

4.   The failure of either party to exercise in any respect any right provided for herein shall not be deemed a waiver of any further rights hereunder.

5.   The captions and headings in this Agreement are intended only for convenience, and will in no circumstances be construed to define, limit or describe the scope or intent of this Agreement, nor in any way affect the interpretation of this Agreement.

6.   No agency, partnership, joint venture or employment relationship is created as a result of this Agreement and neither party has any authority of any kind to bind the other in any respect.

7.   Notices. All notices under this Agreement will be in writing and will be deemed to have been duly given when received, if personally delivered or sent by certified or registered mail, return receipt requested; when receipt is electronically confirmed, if transmitted by facsimile or e-mail; or the day after it is sent, if sent for next day delivery by recognized overnight delivery service.

I agree to the above terms and conditions of this Agreement, and that these terms and conditions will govern my participation in any Event. I understand that this Agreement contains a limitation of liability provision, which I have read, understood and consented to in a sober state of mind.

Sign Here

Name:

Participant Information

Name:
Age:
Email:
Phone number:

Emergency Contact Name:
Emergency Contact Phone #:
Emergency Contact Email:
Relationship to you:

 


Community Breathwork Participation Agreement

Please read the following information. If you have any questions, please check with one of the facilitators. Community Breathwork is intended as a personal growth experience and should not be looked upon as a substitute for psychotherapy. Community Breathwork can involve dramatic experiences accompanied by strong emotional and physical release. 

This practice is not appropriate for pregnant women, or for persons with cardiovascular or heart problems, severe hypertension, severe mental illness, recent surgery or fractures, glaucoma, retinal detachment, osteoporosis, acute infectious illness, or epilepsy.  Persons with medical or mental health contraindications, under medical supervision, with a history of mental health disorders or using prescription medications should consult their doctor prior to participating in a Community Breathwork event.  If you have asthma, please bring your inhaler to the event.

I HAVE READ THE FOLLOWING STATEMENTS 

I certify that I am in good physical and mental health meaning that I am psychologically and physically capable of participating in Community Breathwork and do not have any medical or mental health contraindications that would prevent me from safely participating in a Community Breathwork event.

I understand and agree that my participation in Community Breathwork is voluntary and at my own risk.

I understand that Community Breathwork practice is intended as a personal growth experience and is not a substitute for psychotherapy or medical treatment.

I understand that Community Breathwork could involve dramatic experiences, be accompanied by strong emotional and physical release and/or cause physical, emotional and mental stress or anxiety.

I understand that the use or possession of illicit or controlled substances is expressly prohibited before, during or immediately after a Community Breathwork Event.

I agree to indemnify and hold harmless MMClinic LLC & MMTraining LLC (hereinafter collectively referred to the Center for Medicinal Mindfulness or MM) and each of their agents, contractors, affiliates, representatives, and partners from and against any and all injuries, losses, damages, reasonable costs (including reasonable attorneys’ fees and expenses), liabilities or expenses arising from or caused by my participation in Community Breathwork. 

Community Breathwork Participant Contract Release, Waiver, and Indemnity of Liability Agreement

This form must be completed by you (the “Breathwork Participant” or “Participant”) at your first Community Breathwork event (“Program”) and then once every calendar year thereafter. 

This is a legally binding agreement (“Agreement”) between you the Breathwork Participant and MMClinic LLC & MMTraining LLC, its officers, agents, principals, employees, and volunteers (hereinafter collectively referred to as “MM”). Please read the terms of this Agreement carefully. You must read, agree to and sign this Agreement before participating in any MM Program. Do not sign this agreement if you do not agree or do not understand its terms written below.

MM reserves the right to decline any individual interested in participating in any Program at any time and for any reason MM may deem appropriate.

In consideration of being admitted to the Program and permitted to participate in the activities and Community Breathwork I hereby agree as follows:

 

  1. This Agreement is made and entered into voluntarily by you the Breathwork Participant. You agree to take full responsibility for your participation in the Program and all outcomes resulting from such participation. You agree to ask for additional support as needed from MM. You accept the inherent risks of the Program and acknowledge that your interest in this type of adventure and your desire for experiences beyond the normal safety and comfort of your ordinary day-to-day experiences is in part the reason for your participation in the Program.  
  1. Breathwork Participant has reviewed the medical contraindications outlined above and certifies that he/she does not have any medical or physical conditions which would impair or affect his/her ability to engage in any activities or which would cause any risk of harm to Breathwork Participant, other participants and/or MM or otherwise endanger Participant’s health while attending a Community Breathwork Program. Participant further agrees that it is Participant’s responsibility to maintain the accuracy and contemporaneousness of all relevant medical information. MM will assume that Participant’s medical statement is correct until Participant files an updated or has corrected the information. The medical information is fully incorporated by reference within this agreement. 
  1. Participant is aware that certain activities he/she may engage in during the Program are physically, emotionally and mentally stressful. Participant agrees to assume full responsibility for his/her own physical, emotional and mental health and hold harmless MM from any physical, emotional and/or mental damage that may be attributed to Community Breathwork. Participant further holds harmless MM from any and all loss, liability, injury, damage or cost which may arise out of or in connection with participation in the Program. 
  1. Participant understands and agrees that he/she is attending the Program at the discretion of MM and can be dismissed from the Program at any time without being informed of the reason for dismissal. 
  1. Participant waives, releases and discharges any and all claims, rights and/or causes of action which he/she now have or which may arise out of or in connection with participation in the Program as well as which may arise out of or in connection with Participant’s attendance and/or participation in the activities associated with the Program. Therefore, under no circumstance will Participant prosecute or present any claim for personal injury, property damage or any other cause of action against MM and each of their agents, contractors, affiliates, representatives, and partners.
  1. This agreement is binding on Participant’s heirs, assignees, dependents, personal representatives and estate. 
  1. No oral representations, statements or inducements have been made to Participant to cause them to enter into this agreement. 
  1. Breathwork Participant agrees that any dispute or controversy arising under or relating to this Agreement or the Program shall be governed by and construed in accordance with the laws of the State of Colorado excluding its conflict of law rules. You agree that any cause of action arising out of or related to this Agreement must commence within one (1) year after the cause of action arose; otherwise, such cause of action is permanently barred. You irrevocably consent to the exclusive personal jurisdiction of the Colorado State Court located in Boulder, Colorado for any suit or action arising from or related to this Agreement and waive any right you may have to object to the venue of such courts.  At the choosing of MM in its sole discretion any claim or controversy that arises out of or relates to this Agreement, 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 in arbitration may be entered in any court with jurisdiction. Should MM be successful in bringing an action to enforce the terms hereof or successful in defending itself from a suit brought by Participant, MM shall recover all costs and expenses incurred in such action, including reasonable attorneys’ fees. 
  1. Should any provision of this Agreement be held invalid or illegal, such illegality shall not invalidate the remainder of this Agreement. In that event, this Agreement 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. 

I agree to the above terms and conditions of this Agreement, and that these terms and conditions will govern my participation in Community Breathwork. I understand that this Agreement contains a limitation of liability provision, which I have read, understood and consented to in a sober state of mind.

Sign Here

Name:

Participant Information

Name:
Age:
Email:
Phone number:

Emergency Contact Name:
Emergency Contact Phone #:
Emergency Contact Email:
Relationship to you:

 


Yoga Participation Agreement

If at any time during a yoga class or experiential, you feel discomfort or strain, gently come out of the posture. You may rest at any time during the experience. It is important in yoga that you listen to your body, and respect its limits on any given day.

By signing the following waiver of liability I hereby agree to the following:

  • I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I will continue to breathe smoothly. I assume full responsibility for any and all damages, which may incur through participation and attendance of the venue, and waive all liability of the venue and the instructor.
  • I understand that Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program, if required.
  • If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician’s approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against the instructor and all related facilities and premises for any personal injury or negligence.
  • In addition, I will inform the instructor in writing of any health related issues I have that may affect me while participating in the class.
  • The facility and the instructor are not in any way responsible for any loss or damage of your personal property.
  • I knowingly, voluntarily and expressly waive any claim I may have against the instructor or the facility, or any of its staff for injury or damages that I may sustain a as a result of participating in the class. I, my heirs and legal representatives forever release, waive, discharge and covenant not to sue the instructor, the venue or any of its staff for any injury or death caused by their negligence or other acts.

Cannabis may not be safe to use under certain medical conditions. I affirm that I understand the risks associated with cannabis consumption, and I affirm that I alone am responsible to decide whether or not to consume cannabis and at what dose and frequency. I understand a Designated Driver is required after consuming cannabis.

If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect and the offending provision or provisions severed here from. I have carefully read and fully understand and agree to the above term of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognize that my signature serves as complete and unconditional release of all liability to the greatest extent allowed by law and that it cannot be changed orally.

Signature for Yoga Participation Agreement

Name:

Covid-19 Safety - Only Required for In-Person Training Options

Please read this consent form carefully and let us know if you have any questions. When you sign this document, it will be an official agreement between you the Client and the Center for Medicinal Mindfulness (hereafter “the Center”). This document informs you of risks related to COVID-19 during any client services offered or performed by the Center.

Colorado Governor Jared Polis and the Colorado Department of Public Health and Environment (“CDPHE”) have authorized the limited recommencement of critical business, including behavioral health care, in Colorado under certain conditions. See Executive Order D-2020-091; and, Public Health Order 20-28.d. COVID-19 has also been declared a worldwide pandemic by the World Health Organization and is a highly infectious disease that spreads by person-to-person contact. The Center continues to closely monitor the situation and has implemented measures consistent with CDPHE public health orders aimed to reduce the spread of COVID-19. However, given the nature of the virus, there remains an inherent risk of becoming infected with COVID-19 by virtue of proceeding with your treatment/procedure/session.

As a client of the Center for Medicinal Mindfulness, your health and safety is our biggest priority. Please review the following provisions and initial each statement to indicate that you understand and agree to these actions:

  • I understand that while the Center has implemented measures to limit the spread of COVID-19 there remains an inherent risk of becoming infected with COVID-19 by virtue of proceeding with this treatment/procedure/session.
  • I have not tested positive for COVID-19 nor has anyone in my household for the last 14 days. Further, I will cancel or reschedule the next future appointment, if I have been in contact with someone who has tested positive within the last 14 days.
  • I have been fully vaccinated for COVID-19 at least two weeks prior to my scheduled session, and have provided proof of vaccination. Fully vaccinated is defined as one dose of the Johnson & Johnson’s Janssen vaccine or two doses of the Pfizer-BioNTech or Moderna vaccine.
  • I consent at all times to wearing a mask, hand washing, and other procedures as instructed by the Center’s staff and practitioners.
  • I have not exhibited any symptoms of COVID-19 including a combination of cough, fever, body aches, fatigue, and chest tightness within the last 14-days. Further, I will only keep my in-person appointment if I am symptom free.
  • I agree to immediately inform the Center if I or a member of my household test positive for COVID-19 or begin to exhibit symptoms of the virus within 14-days of my treatment/procedure/session. 
  • I have been given the option to defer my treatment/procedure/sessions to a later date or to participate in tele-health measures and am declining this option.
  • Where feasible, I agree to keep a distance of approximately six feet and minimize physical contact (e.g. no shaking hands) while at the Center.
  • I agree and consent to having my temperature taken prior to my appointment. If it is elevated (100 Fahrenheit or more), or if I have other symptoms of the coronavirus, I agree to reschedule the appointment.
  • I agree to take proactive steps between appointments to minimize my exposure to COVID-19. 
  • I affirm and understand that if my appointment or workshop is canceled or rescheduled due to myself or a MM practitioner receiving a COVID-19 diagnosis or positive test, that I am solely responsible for any travel expenses and arrangements that may have been made in preparing for my appointments or workshop. I further understand and agree that MM will reschedule my appointment for a later date and not refund my session due to a COVID-19 diagnosis or positive test. 

Informed Consent

This agreement supplements the general informed consent agreement that we agreed to at the start of our work together. Your signature below shows that you agree to these terms and conditions. 

Sign Here

Name:

Psychedelic Experience Agreement

As representatives of the psychedelic community we choose to exemplify safe psychedelic experiences. Safety allows for depth, healing, and awakening and is a universal right for all people in psychedelic spaces. The purpose of this agreement is to clarify expectations and appropriate behavior before we have a psychedelic experience together and to help elicit the safest spaces we can create for psychedelic healing purposes.

The Center for Medicinal Mindfulness psychedelic therapy center, the Psychedelic Sitters School training program, as well as our facilitators, educators, staff members, students, and community members all agree to comply with this simple safety agreement. Professional members of our program also fully comply with our code of conduct policies as outlined in the Medicinal Mindfulness Safe Community Policy. 

This is an evolving document, and intentionally kept simple and short.  For additional information, to provide feedback, to ask questions about the purpose or reason for a guideline, or for a copy of the Safe Community Policy, please email safecommunity@medicinalmindfulness.org. 

Discussing the principles of the Psychedelic Experience Agreement before personal medicine experiences with friends and allies is strongly encouraged. The number one way to reduce harm is through prevention. Please be an advocate for safety and intentional use in your community. 

First and Foremost

  1. We affirm that this agreement can only be made in a sober state, and we agree that once any medicine is taken, even if the medicine hasn’t activated yet, we will not change the agreement until we are sober again, even if we all agree we want to. We agree to not break or change this agreement even if God/the Divine/the Universe/Truth tells us directly and without a doubt to change it or break it.

Preparation and Support

  1. Before we begin, we agree to complete a simple safety assessment, to be truthful about and discuss our current psychological state and life circumstances. We affirm that we are ready for the experience we’re choosing to have.
  2. We agree to speak at least once before the psychedelic experience for intention setting, safety assessments, and preparation support and at least once after the experience for a safety check-in and integration support. If this is part of a professional service, the full cost of the entire protocol is outlined before we begin.
  3. We agree to have back-up support in the form of a trusted emergency contact and to share the contact information with the facilitator or group. We agree to seek immediate professional support for any significant medical or mental health emergency.
  4. We agree to keep confidentiality and not share details of our experience with others except in situations that require significant intervention to prevent harm or where reporting is legally mandated, such as child or elder abuse, suicidality, or self-harm.

Consent & Physical Safety 

  1. We agree to respect each other’s boundaries, treat each other with respect, and to keep each other safe. We agree to fully comply with all safety requirements of the host and the space. 
  2. We agree to have a conversation around consensual touch before the medicine is taken. Touch is always consensual. Consent about something not discussed cannot be given after a medicine is taken. Permission is always requested and affirmed before touching. We agree that touch is never sexual in a psychedelic therapy session.
  3. We agree to designate a specific location that represents the boundaries of the experience and to not leave the confines of this safe space until the completion of the experience. We agree to not bring into or do anything dangerous or harmful in the psychedelic experience space. We agree to immediately return from using the bathroom to the designated experience location.

Psychedelic Medicine Safety

  1. We agree to only use clean medicine that is tested, accurately measured, and responsibly sourced. We agree to be educated about the medicines we use and their legality. We agree to only use the medicines all participants consent to use, and to not bring any other medicines into an experience without permission. 
  2. We agree to only use medicines that we know are personally safe for us to use physically, mentally, psychologically, and spiritually. We agree to only use as frequently as it is safe to do so, to be educated about safe frequency of use practices, and to be open to non-judgmental feedback regarding the observed effects of our use by our trusted allies and community. 
  3. We agree that anyone imbibing a medicine will not drive, or engage in any behavior that requires sobriety to ensure safety, until the following day, or only until it is safe to do so.

Conflict Prevention & Resolution

  1. We agree to be mindful of externalizing our inner experiences and to be aware of our projections and transference (both positive and negative) that we may place on each other, the experience, the facilitator, or the medicine. We agree to discuss our perceptions and factually assess them, and to check in around feelings of safety or lack of safety if we become anxious or paranoid.
  2. If a conflict or significant disagreement occurs, we agree to engage it compassionately, skillfully, and maturely, and to comply with any community consent agreements related to conflict resolution practices. These agreements are outlined in the Safe Community Policy for the Center for Medicinal Mindfulness and Psychedelic Sitters School.

Professional Standards 

  1. The sitter/guide/therapist/shaman (facilitator) of any experience agrees to share their training and expertise through a disclosure statement, and they affirm to have adequate supervision, training, and the experience necessary to facilitate the psychedelic journey. Fees are clearly outlined, will not change, and are in alignment with the skill, training, experience level of the facilitator, and to similar services within the facilitator’s locale. 
  2. The facilitator agrees to only work within their scope of training and expertise, such as only doing body work if they are trained to do so, or only working with specific clinical concerns (e.g., trauma, PTSD, and other significant mental health issues) if they are trained to do so. 
  3. Facilitators agree to comply with an appropriate code of ethics and code of conduct, and to share this code with clients who request it. Facilitators and trainers of the Center for Medicinal Mindfulness and Psychedelic Sitters School agree to the professional code outlined in the Safe Community Policy. 

Thank you and Safe Travels! 

Many blessings to you on this sacred journey of healing and discovery.

I have read, understood, and agree to the Psychedelic Experience Agreement.

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Community Guidelines for Online & In-Person Training Intensives & Practicums

As with any psychedelic retreat experience, we have community guidelines that support safety and allow for greater transformation. By attending a training intensive or practicum, you agree to comply with these community guidelines. We are a professional psychedelic therapy training program and our guidelines are congruent with what is required to keep everyone safe and to create the most transformational experiences possible.

This document is provided to explain our general community guidelines. For additional information in which these guidelines are based, please review the full Medicinal Mindfulness Safe Community Policy. This agreement is in addition to the Psychedelic Experience Agreement.

Our guidelines reflect the needs of real psychedelic experiences and not “just cannabis.” If you’re not sure about a guideline or if something fits, just ask. These are written by psychedelic medicine practitioners for the benefit of psychedelic medicine practitioners. Standards for online program are the same as in-person sessions. Even if you are in your own home, please engage this space as if we were all together. 

Self-Care is your top priority. Make sure you eat, drink plenty of water, stretch, and if you need to take a break from taking a psychedelic in an experiential session, that’s fine, just let us know.

Confidentiality

  1. What you share stays here, including the names of others. You can share your own experiences with friends/allies but don’t share other people’s experiences, even if their name remains private. Outing someone is never ok. Respect other people’s different needs regarding privacy.
  2. No Screenshots or saving chats. No recording of any conversation or presentation.
  3. You agree to be in a private location, with no one else joining off screen. Wear headphones if necessary.
  4. You are not required to share your personal contact information with anyone. That is why we have the online forum. 

Group Etiquette 

  1. To help attendance: when on zoom, change your profile name to your preferred first name and last name initial. When in-person always wear a name tag or use a “name tent” where you sit. 
  2. Be kind and professional in your communication. 
  3. Be concise and create space for others to share as well. 
  4. Speak only about your own experiences. Please don’t share observations, opinions, or interpret another person’s experience without their permission. Use “I” statements.
  5. After medicine sessions and while everyone is returning, please sit quietly, journal, make art, meditate, drink some juice and have a snack, please no phone calls or texting until we close. This is to keep the experience energetically contained.

Safety & Consent

  1. Once you take the medicine, you agree to remain in your safe space, and to immediately return from using the bathroom. No showers etc. Only go to bathroom, wash your face and hands, and come back to the session. However, if your location becomes unsafe for any reason (a storm in your area, for example) please take care of yourself.
  2. No driving until the next day after a medicine is consumed. 
  3. Create a clear walkway to your bathroom of any tripping hazards.
  4. No ecstatic dancing or big movements in online containers, and only in in-person groups designed for movement practices. 
  5. Fire safety - candles and incense must remain contained and located away from blankets or other flammable material. 
  6. Maintain a receptacle for vomiting just in case so you don’t try to run to the bathroom too quickly. 
  7. Wear comfortable clothes but keep them on, even if you are home, just as you would in a session with a guide. 

Medicine Safety

  1. Cannabis use is encouraged to remain in the afternoon ceremonies.
  2. Responsible medicine use is required. No other medicines are allowed besides cannabis (or ketamine in ketamine related experiences). This is simply not the right container for other medicines and the protocol is not designed to provide a safe container for other medicine experiences. 
  3. Microdosing during the training period is only allowed if already being used, and dosage is limited to 0.1 grams for psilocybin mushrooms, or 10mics of LSD only.
  4. Please let us know if you intend to use an edible for ceremonies. For edibles, we request you know your dose, onset time, and you’ve used the product before. 

Legal Safety

  1. The training program and group events are specifically devoted to the practice of psychedelic cannabis in a legal setting. While we honor underground practices and practitioners, for our program’s safety we ask that this remain separate from the training. We also can’t vouch for the integrity, skill or safety of underground practitioners or communities. Please don’t discuss or provide contact information to underground practices, facilitators, or communities. You can share information about legal retreats that have verifiable information online. Please do not advertise your own underground practices. This request includes legal medicine practices related to underground practices or communities, such as Hape/Rape (snuffs), Sananga (eye drops), or Kambo (frog medicine).  We provide mentorship for underground practices and other medicines through our clinic as a harm reduction and education service. If a community or practice is in a legal “gray area” and you aren’t sure, please ask a facilitator for guidance. 

Ethical Conduct Beyond Our Time Together

  1. For increased safety in post-intensive practice sessions - PSS1-2 Online practice sessions can only be conducted with someone in your cohort until you are credentialed. For in-person practice sessions, you are only allowed to work with people you know and have an already established trust, and who do not have any significant clinical concerns.
  2. We request a four month pause after meeting someone in the training program to begin any new romantic relationship, and to engage in any psychedelic medicine experiences besides cannabis. 
  3. Stay involved in the online community for ongoing support and mentorship. These skills take time to develop and sometimes the water is choppy. Please note that it is extremely common for big internal processes to activate by stepping into being a guide for others. We’re here to support you through your process. 
  4. Participants in this program understand that participating in the training intensives and practicums only partially fill the necessary requirements to work professionally and ethically. Full requirements for credentialing are always listed on the program website. 

Conflict Prevention & Resolution

  1. We agree to be mindful of externalizing our inner experiences and to be aware of our projections and transference (both positive and negative) that we may place on each other, the experience, the facilitator, or the medicine. We agree to discuss our perceptions and factually assess them, and to check in around feelings of safety or lack of safety if we become anxious or paranoid.
  2. If a conflict or significant disagreement occurs, we agree to engage it compassionately, skillfully, and maturely, and to comply with any community consent agreements related to conflict resolution practices. These agreements are outlined in the Safe Community Policy for the Center for Medicinal Mindfulness and Psychedelic Sitters School.
  3. If you see something or hear about something that you are not sure is safe, please say something. We are here to help. Our facilitators are trained to correct behavior from a compassionate, harm reduction, and educational perspective in an appropriate and nonjudgmental way. 

I have read, understood, and agree to the Community Guidelines for Online & In-Person Training Intensives & Practicums.

 

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Demographics Survey & Need-Based Diversity Scholarship Application

We officially initiated our need-based diversity scholarship program in 2019 to increase the accessibility and inclusivity of our services and training program. These scholarships provide a 10-40% discount on any program tuition or group participation fee. Scholarships for individual sessions are also regularly available and are based on an hourly flat fee discount. Medical evaluations and membership applications are already reduced to the lowest rate possible, and ketamine administration and medical oversight are discounted additionally through group rates. (Cannabis sessions are more accessible and very effective.) Payment plans are also available to increase accessibility. Scholarships renew annually.

Notice of Non-Discrimination and Prohibition of Harassment: Committed to equality of transformational opportunity, the Center for Medicinal Mindfulness and Psychedelic Sitters School does not discriminate in offering access to its programs, activities, or employment on the basis of race, color, gender, age, national or ethnic origin, religion, disability, veteran’s status, sexual orientation, gender identity, gender expression, responsible psychedelic medicine use (as defined in the Medicinal Mindfulness Safe Community Policy), or any other status protected by law.

Demographic Questions: The following demographic questions are optional but help us track our progress around inclusivity and diversity, as well as help us determine an appropriate scholarship amount if one is requested. All information is kept strictly confidential.

See the Medicinal Mindfulness Safe Community Policy for additional information. 

SCHOLARSHIP APPLICATION

If you are applying for a scholarship, you affirm that you are not independently wealthy, have a high salary, a trust fund, significant investments or property, a wealthy partner or family support, etc., and that you have a legitimate financial need for a scholarship. 


INTERVIEW REQUIREMENT

Once all of your material is submitted and application fee received, you will be invited to a 45-60 minute admissions interview. This is a structured interview to assess your readiness to join our program and to get to know you and your interest in becoming a psychedelic guide. Please review your safety assessment. This is also an opportunity to ask questions about safety, the program, and what to expect. 

Your interviewer writes a brief report and presents it to our admissions team for review. Applications are reviewed on an ongoing basis, so you should hear from us pretty soon after your interview. 


NEXT STEPS & JOINING THE COMMUNITY

We will review your application and respond by email regarding your acceptance, next steps, and additional information about joining our program. Once approved, if any tuition payments are required, you will be sent a link to pay. If you are approved for a scholarship, the scholarship will be automatically deducted from all tuition and credentialing costs.

Once your deposit is paid, you’ll receive information about joining the online training platform, and will be given access to all relevant online material and lectures. Most video lectures are required PRIOR to attending your first intensive. The order of the training program will be outlined in the online syllabus. 

Thank you again for your interest in our program. We hope to welcome you soon to the expedition!


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