I consent that I am over the age of 21 or older; am NOT affiliated with or employed by law enforcement or any other government agency involved in law enforcement (if I am a law enforcement officer, as a condition of my Membership I agree to identify myself); sincerely believe that adults should be allowed to freely exercise their religious beliefs and consume entheogenics; believe that adults over the age of 21 should have a safe space to consume and / or obtain entheogenics as religious sacrament and for therapeutic use; believe that I would suffer some form of harm or loss if a US government organization or body ruled that I could not practice my religious beliefs; and agree to receive marketing and communications as part of my Membership on the basis that I may opt-out at any time.

I am executing this Waiver of Rights and Release of Liability as of today’s date in favor of Psilyshop, and the members, managers, directors, officers, employees, volunteers, successors, assigns, and agents of. I accept the conditions, risks and nature of receiving Sacrament from Psilyshop in the form of psilocybin and psilocin, as well as guidance on its use (“Sacrament”) and declare that I am choosing to participate of my own free will and as part of my sincere religious beliefs or therapeutic need which are honest and true. I understand that psilocybin is viewed by law enforcement in many jurisdictions as a controlled substance, and accept the risks of possession and consumption. I certify that I have thoroughly researched and educated myself about the potential risks, side effects, and long-term consequences associated with the Sacrament and expressly and specifically accept and assume such hazards and risks, including any and all risk of injury, harm, loss, or death that I may incur as a result of my participation in the use of Sacrament. I hereby fully and forever release and discharge Psilyshop from any and all claims (including negligence claims), demands, expenses, lawsuits, and any other liability of whatever kind or nature, either in law or in equity, of or to me or any other person, directly or indirectly arising from or in connection with my participation in the use of Sacrament. I covenant not to make, initiate, or bring any such claim or other legal proceeding or demand against Psilyshop, nor join or assist in the prosecution of any claim sustained by me and I waive any right I may have to do so. I fully and forever release and discharge Psilyshop from liability under such claims or demands. I agree that any sacrament issued to me by Psilyshop shall only be consumed by myself personally and not sold or given to any other person. I agree to provide all the relevant information about my medical history, my mental and physical health and any other information that may serve to protect my health during this process. I am aware that I am to answer all questions honestly during the screening process.

I agree that I am not allowed to purchase Sacrament and that any Sacrament I receive will be associated with a donation of any amount. I understand and agree that I can be excluded from membership of Psilyshop for any reason. I confirm that I am of sound mind and body to sign this Release. I have not withheld any information that would influence Psilyshop’s decision to allow me to participate in a Membership or use of the Sacrament. By submitting this form, I acknowledge that I have read and fully understood all of the terms of this release and that I am voluntarily giving up substantial legal rights, including the right to sue Psilyshop, without any inducement, assurance, or guarantee being made to me. I completely and unconditionally release all liability to the greatest extent allowed by law. I acknowledge that I have read, understood, and accepted the Rules for Membership, the Waiver and Release of Liability.