Thank you for choosing Mooonchild Infusions! We value your interest in our services. Please fill out the form before buying tickets for events or products that suit your needs. For event bookings—public or private—each person in your group must complete this form to access our events and services. Make sure the address in the form is correct for product shipments. All sales are final, so choose wisely. We are honored to help you with your psychedelic journey!

Age Verification

Are you 21 years of age?

Yes

Name

First Name

Last Name

Guest List

List all legal names of your guest(s). All members must fill out registration.

Referral

Who sent you?

Phone number

Event details are sent via text

Health

I understand the importance of answering these questions truthfully and accurately to ensure my safety while participating in sessions

Food Restrictions

Please list any food relation allergies or restrictions

Health 2

Do you have any life threatening illness that require an Epi-pen?

Health 3

Is there anything facilitators should know regarding a medical, physical or mental condition that would interfere with the participants interaction in the session at any point?

Health 4

Are you currently on any medications?

Emergency contact

First Name

Last Name

Emergency contact number

(###)

###

####

Waiver

AGREEMENT OF RELEASE AND WAIVER OF LIABILITY I hereby agree to the following: As I participate in activities offered by the hosts and special guests, I understand that the offerings of this event are not a substitute for medical attention, examination, diagnosis, or treatment. I will receive fitness related information and instruction during this activity. I recognize that exercise requires physical exertion that may be strenuous and may cause physical injury and I fully assume the risks and hazards. If at any time during the activities I feel discomfort or pain, I will inform and seek assistance from the established safety coordinators. I will listen to my body and respect its limits during and immediately following the activity. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any activity. I represent and warrant that I am physically fit and I have no medical condition that would prevent my participation in the activity. The hosts, guests, and premises owner and lessee, are not liable for any injury, or damages, to person or property, resulting from my participation in this activity. Exclusion of Participation: In the unfortunate circumstance, if a guest conceals physical and/or health issues, is unfit, and/or causes disruptions and/or endanger the health and safety of other participants, facilitators, or equipment, we reserve the right to remove the guest. In the event of removals, costs paid in advance are non-refundable and any costs arising from disturbance or removal, included but not limited to, damages, emergency bills or fines are to be paid by the guest. Confirmation: I have read the above release and waiver of liability and fully understand the contents as well as the Refund/Cancellation Policies. I voluntarily agree to the terms and conditions stated above. BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL SIGNATURE.

Agree

Disagree