Participant Information Form

Participant First Name

Participant Last Name

Address

City

State

Postal Code

Phone

Date of Birth

Gender

Height

Weight

Occupancy Preference

Double occupancy is not guaranteed and will be based on participant preferences.

Roommate Preference

Do you have any dietary needs or restrictions?

Participant Agreement

This Experience Participation Agreement, Waiver, and Mutual Non-Disclosure Agreement (the “Agreement”) is entered into by and between Hampui, LLC (hereinafter referred to as the “Company”) and the undersigned participant (“Participant”), effective as of the date of acceptance (the “Effective Date”).
This Agreement governs Participant’s involvement in any retreat, ceremony, program, or event (collectively, the “Experience”) organized, hosted, or facilitated by the Company, and includes provisions related to confidentiality, assumption of risk, liability waiver, media release, dispute resolution, and general participation terms.
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1. Confidentiality (Mutual Non-Disclosure)
Both Participant and Company agree to maintain the confidentiality of any non-public, personal, proprietary, or sensitive information disclosed during the Experience (“Confidential Information”).
Confidential Information includes, but is not limited to:
1. Personal experiences shared by participants
2. Facilitator insights, processes, or materials
3. Any information disclosed in connection with the Experience
Confidential Information does not include information that:
1. Is or becomes publicly available without breach of this Agreement
2. Is lawfully obtained from a third party without restriction
Both parties agree to:
1. Use reasonable care to protect Confidential Information
2. Not disclose or use such information outside the scope of the Experience
These obligations shall survive indefinitely beyond the termination or completion of the Experience.
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2. Health Acknowledgment and Responsibility
Participant represents that they are in sufficient physical, mental, and emotional condition to participate in the Experience.
Participant understands:
1. The Company does not provide medical or psychological advice
2. Participation is voluntary and undertaken at Participant’s own risk
3. Any concerns should be addressed to a licensed physician and/or mental health professional prior to participation
Participant is solely responsible for their health decisions before, during, and after the Experience.
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3. Experience Terms and Modifications
Participant acknowledges and agrees to the itinerary, accommodations, pricing, and cancellation policies outlined on:
https://psychedeliciq.com/peru/
Participant understands that reasonable modifications may occur due to logistics, safety, facilitator availability, or other factors, provided that such changes do not materially reduce the overall value of the Experience.
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4. Assumption of Risk
Participant understands that participation in the Experience involves inherent risks, including but not limited to:
1. Physical activities (e.g., hiking, swimming, yoga)
2. Adventure activities (e.g., climbing, ziplining, surfing)
3. Travel-related risks
4. Environmental exposure (remote or international locations)
5. Participation in ceremonies and group processes
These risks may result in:
1. Injury or illness
2. Property damage
3. Emotional or psychological distress
4. Permanent disability or death
Participant knowingly and voluntarily assumes all risks, whether known or unknown.
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5. Psychedelic and Sacred Medicine Risk Disclosure
Participant acknowledges that certain Experiences may involve the use of traditional, ceremonial, or psychedelic substances (“Sacred Medicines”).
Participant acknowledges that:
1. The Company does not diagnose, treat, or cure any medical or psychological condition
2. Participant will not ingest any pharmaceutical medication, chemical, or drug (including cannabis) 24 hour prior to any ceremony.
3. Participant is solely responsible for their own health and decision. 
Participant voluntarily chooses to participate with full awareness of stipulations and accepts full responsibility for any outcomes.
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6. Release and Waiver of Liability
To the fullest extent permitted by law, Participant releases and holds harmless the Company and its officers, directors, employees, contractors, agents, and affiliates from any and all claims, liabilities, damages, or causes of action arising out of or related to participation in the Experience.
This includes claims based on:
1. Negligence
2. Personal injury
3. Psychological or emotional harm
4. Property damage
This release does not apply to:
1. Gross negligence
2. Willful misconduct
Participant acknowledges they may be waiving significant legal rights, including the right to sue.
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7. Indemnification
Participant agrees to indemnify, defend, and hold harmless the Company from any claims, damages, losses, or expenses (including attorneys’ fees) arising out of:
1. Participant’s conduct
2. Breach of this Agreement
3. Participation in the Experience
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8. Media Release and Content Rights
Participant grants the Company the irrevocable right to record, reproduce, and use Participant’s voice, likeness, image, statements, and participation (“Content”) in any format or media.
Participant acknowledges that:
1. The Company retains all rights to such Content
2. Content may be used for educational, promotional, or commercial purposes
3. Participant will receive no compensation
Participant releases the Company from any claims arising from the use of such Content.
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9. No Guarantees
Participant acknowledges that:
1. Results from the Experience are not guaranteed
2. Outcomes vary significantly between individuals
3. The Company makes no promises regarding healing, transformation, or outcomes
All services are provided without warranties of any kind.
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10. Force Majeure
Neither party shall be liable for failure or delay in performance due to events beyond reasonable control, including but not limited to:
1. Natural disasters
2. War or terrorism
3. Travel disruptions
4. Government restrictions
In such cases:
1. The Experience may be modified, postponed, or rescheduled
2. Participant may not be entitled to a refund
3. The Company will make reasonable efforts to transfer participation to a future date
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11. Dispute Resolution; Arbitration
Any dispute, claim, or controversy arising out of or relating to this Agreement or the Participant’s involvement in the Experience shall be resolved exclusively through binding arbitration.
1. Arbitration shall be conducted in St. Louis, Missouri
2. Arbitration shall be administered in accordance with the rules of a recognized arbitration body mutually agreed upon by the parties
3. The arbitrator’s decision shall be final and binding
Participant waives the right to:
1. File a lawsuit in court (except to enforce arbitration)
2. Participate in a class action or collective proceeding
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12. Governing Law and Jurisdiction
This Agreement shall be governed by and construed in accordance with the laws of the State of Missouri, without regard to conflict of law principles.
Any legal action permitted outside of arbitration shall be brought exclusively in the state or federal courts located in St. Louis, Missouri, and the parties consent to the jurisdiction of such courts.
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13. Entire Agreement
This Agreement constitutes the entire agreement between the parties and supersedes all prior discussions or agreements.
Any amendments must be:
1. In writing
2. Signed by both parties
If any provision is found unenforceable, the remaining provisions shall remain in full force and effect.
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14. Acknowledgment and Acceptance
Participant acknowledges that they:
1. Have read and understood this Agreement
2. Have had the opportunity to seek independent legal advice
3. Voluntarily agree to all terms
By signing or accepting this Agreement, Participant agrees to be legally bound.

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