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Health Declaration

Please fill out the following form
in order to participate in our activity.

Have you been hospitalized in the last 12 months?
Are you suffering from a medical condition, illness, or injury?
Do you take any medication?

Thanks for submitting!

**Liability Waiver** I, [________________________], am thrilled to partake in the transformative Kambo wellness activities offered by [Kambo wellness- AR]. I understand that Kambo holds the potential for incredible benefits, such as increased vitality and mental clarity. By engaging in these activities, I acknowledge the importance of personal responsibility for my own well-being. I trust in the expertise of the team at [Kambo Wellness- AR] to guide me safely through this journey. In signing below, I release [Kambo Wellness- AR], its staff, and affiliates from any liability. I eagerly anticipate the positive experiences and growth that await me through Kambo wellness. Participant's Name: _______________________ Participant's Signature: _______________________ Date: _______________________

Emergency Contact Form

YOUR OWN DETAILS:

YOUR EMERGENCY CONTACT DETAILS:

Thanks for submitting!
We’ll contact this person only in case of emergency.

Disclaimer: Please note that outcomes derived from ancient medicinal practices can vary significantly among individuals.

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