Sovereign Wellness, dba Medicine Box
Assumption of Risk and Release of Liability
I am attending a facilitated guidance with plant-based therapeutics to be located on “ZOOM” and SKOOL platforms (the “Premises”) held by Sovereign Wellness INC, a company organized under Delaware State law and its affiliates and assigns (collectively, “Sovereign”), in August 2022, that will include the Activities as defined herein (the “Experience”). This document contains an Assumption of Risk and Release of Liability (the “Release”) that I will voluntarily sign in order to attend the 12-week experience or any portion thereof.
I am the individual named below, and on behalf of myself and any spouse, parents, children, agents, assignees, heirs, executors, administrators, beneficiaries, trustees or legal representatives, (referred to as “I”, “my”, or “me”), and in consideration of being permitted by Sovereign to attend the Experience and in recognition of Sovereign’s reliance on this Release, I hereby acknowledge and agree to all terms and conditions set forth herein.
I hereby acknowledge that the Experience will include, but not be limited to, certain Activities (as defined in this Release) on the Premises, which is my personal, physical space and my internal environment that may contain: thoughts, perceptions, feelings, and other comfortable and uncomfortable emotions that I must navigate on my own, with the guidance of my facilitator. I also agree that I am willingly participating in this Experience, knowing that I will be entering into a space of deep introspection, reflection and at times vulnerable spaces with myself that are supplemented by the use of plant-based therapeutics, which contain compounds that can amplify my Experience. As an invitee to the Experience, I acknowledge that Sovereign has taken extraordinary care to maintain the Experience in a reasonably safe condition and I agree that I have been warned of the possible risk of, and am responsible for, any injury (physical, emotional mental, and spiritual) as a result of the Activities or any occurrence from participating in the suggested use, guided practices and implementation of newfound perspectives and lifestyle discoveries.
The Experience will include, but not be limited to, the following Activities: participating in a 12 Week microdosing journey, journaling, processing with self and facilitator, sharing newfound perspectives openly and vulnerably, interacting with my family members, co-workers, and friends throughout the duration of the Experience as I navigate transformative change within myself, with guided practices and suggestions made by Sovereign; at will testimonials of Experience; and exploring my individual consciousness throughout Experience.
I agree that I am responsible for bringing my full self; with an open and exploratory mind; all essential information and communication that may assist me in my journey and anything I may require consistent with reasonable necessities and my personal needs. I agree that the Experience provided by Sovereign has been reasonably researched and framed out for optimal insights, however, unexpected circumstances may arise, and I do not hold Sovereign responsible for any issues with the Experience.
I also acknowledge that If I need assistance at any point, or if I have concerns about my health, I will immediately request help. If the conditions of my well-being become confusing or I find that my Experience stops being effective, I will either verbalize or put in writing to the facilitator of Experience, and an authorized representative of Sovereign will provide, at best, a safe place to actively speak and be heard. If I have any questions or concerns about the safety of my Experience, the plant-based therapeutics, or any other situations with respect to the activities along the journey of the Experience, I will not hesitate to ask for information and/or assistance.
I hereby certify, confirm, and agree that my physical, emotional and mental health is in a condition that will not cause adverse interactions with the Activities that may include circumstances, such as newfound internal insights such as mental thought patterns, old emotions, disturbance in sleep, emotional responses that require personal agency and accountability. In other words, I represent that, solely, for example, I do not have or have identified in writing to Sovereign that I do have hypertension, heart conditions or asthma, take blood pressure medications or epilepsy. If I have any health conditions, I agree to bring any necessary medications and inform Sovereign in writing of my need for such medication and where they are located. I acknowledge and accept the risks of such Activities, including but not limited to dehydration, stress, anxiety, lightheadedness, or lack of sleep.
I hereby consent to receive medical treatment deemed necessary if I am injured or at the sole discretion of Sovereign, require medical attention during my participation in the Activities. I understand and agree that I am solely responsible for all costs related to such medical treatment and any related medical transportation. I hereby release, forever discharge, and hold harmless Sovereign from any claim based on the provision or omission of such treatment or other medical services.
I understand and acknowledge that, during the Activities, I and other participants in the Experience will divulge personal information with the expectation of privacy and to be kept confidential. I agree that, whether I perceive any information to be sensitive in nature or not, I will keep confidential all information divulged during the Activities.
Upon the start of the Experience, I will fully and voluntarily agree to the following statements:
1. I knowingly and willingly consent to attend the Experience hosted by Sovereign during a 12 Week period and assume all associated Risks.
2. I understand that Experience and plant-based therapeutics are different for everybody and my experience is my own; individual and unique.
3. I acknowledge that there is no absolute, set method to conduct this type of Experience and the 12-week journey will be subjective to the level of participation and time that I put in.
4. I confirm that I understand that Sovereign is not responsible for my individual Experience but only to act as a guide, providing reasonable feedback, suggestions and assistance along the way.
5. I confirm that I will do my best to stay accountable to my own healing during the Experience and utilize the feedback, suggestions, and assistance to the best of my knowledge.
6. If I have to drop out before the 12 weeks are over, I will let Sovereign know in writing my reasoning and will inform Sovereign immediately.
7.) I understand that if I drop out before the 12 weeks are over due to anything unrelated to catastrophic injury, severe illness, or any debilitating circumstances that are not within my control I will not hold Sovereign responsible for reimbursement for any time that will be missed.
I hereby agree to assume all Experience Risks associated with this type of Citizen Science and transformational work. I understand that it is an impossibility for Sovereign to ensure that every participant, individual, and the group will all have similar, including but not limited to, profound breakthroughs, radical transformations, instant healing, and change, and I willingly agree to
participate in the Experience. I hereby expressly waive and release all claims against Sovereign arising out of my participation in the Experience with respect to all transformative Risks.
I hereby expressly waive and release any and all claims, now known or hereafter known, against Sovereign, on account of injury (physical, mental, emotional, spiritual), disability, death, or property damage arising out of or attributable to the Experience and/or my participation in the Activities, whether arising out of the ordinary negligence of Sovereign or otherwise. I covenant not to make or bring any such claim against Sovereign and forever release and discharge Sovereign from liability under such claims.
This Release constitutes the sole and entire agreement between Sovereign and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to the such subject matter. If any term or provision of this Release is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Release or invalidate or render unenforceable such term or provision in any other jurisdiction.
BY MAKING THIS PURCHASE THIS, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL TERMS AND CONDITIONS OF THIS RELEASE AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO BRING CLAIMS AGAINST SOVEREIGN.