Event Membership Membership By digitally signing this form, I authorize Kamentsa Inga Church, The Soul of the Hummingbird, to take my photograph, video or other digital media (“photo”) in any of its publications, including web-based publications, without payment or other consideration. YesNo By digitally signing this form, that I understand the need and importance to answer the following questions truthfully, as accurately as possible and to the best of my knowledge and hability. I understand that my responses to the above screening questions determine my eligibility to participate in sacred ceremonies with Kamentsa Inga Church, The Soul of the Hummingbird; and if I am denied participation in a ceremony due to my responses to the above screening questions, such denial is based on a determination that my exclusion is for the safety and benefit of myself and other ceremony participants. I understand that this membership form is an integral part of Kamentsa Inga Church, The Soul of the Hummingbird Waiver of Liability form. By digitally signing this form, I represent and warrant that I am of sound mind and body and believe that I am mentally and physically fit to participate in a ceremony with Kamentsa Inga Church, The Soul of the Hummingbird, notwithstanding the determination of its staff regarding my fitness to participate. By digitally signing this form, declare that in spite the fact that I may have physical and/or mental illnesses, I believe that I am fit normasly to participate in a ceremony with Kamentsa Inga Church The Soul of the Hummingbird. For the healing of these. By digitally signing this form, I grant Kamentsa Inga Church, The Soul of the Hummingbird, permission to take and publish my photograph, video or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I authorize, under my sole responsibility and at my own risk and expense, Kamentsa Inga Church The Soul of the Hummingbird to administer to me its sacred sacrament ayahuasca-yage and the other elements that the church considers necessary for my physical and spiritual healing process. Previous Next Medical History: Do you have a history of, or currently suffer from any serious health condition or mental illness? If the answer is yes, briefly explain. YesNo Are you currently or have you been taking (in the past twelve (12) months) any type of medications? YesNo Have you ever consumed natural entheogenic/psychoactive medicines before, such as Mushrooms (psylocibin), Cannabis, Peyote, San Pedro, Ayahuasca-Yage, among others? If your answer is yes, please elaborate. YesNo Do you have any experience consuming natural entheogens in a sacred or ceremonial context? YesNo Have you had any medical procedures or surgeries in the past 2 months? If your answer is yes, explain your current health status. YesNo Are you 18 years or older? YesNo We're sorry, but you are not eligible to participate in the ceremony at this time. Please email us at [email protected] and provide your zelle information so we can issue you the refund. Thank you for your understanding. Are you currently pregnant? YesNoN/A We're sorry, but you are not eligible to participate in the ceremony at this time. Please email us at [email protected] and provide your zelle information so we can issue you the refund. Thank you for your understanding. Previous Next First Name: Last Name: DOB: Email Address: Phone Number: Emergency Contact: First Name: Last Name: Emergency Phone Number: Previous Next Select Your CityMay 2026 Von Omry, TXMay 2026 Littleton, NHMay 2026 Lakeview, CAMay 2026 Miami, FLJune 2026 Von Ormy, TXJune 2026 Tampa, FLJune 2026 Littleton, NHJune 2026 Glenville, GA Sign Here: Clear Previous Next
