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Welcome

As a part of our commitment to giving our clients the best service, we ask that you sign this form before  we can legally serve you at Support Sessions and Events. Thank you so much!

BONA FIDE HARM REDUCTION AGREEMENT, PARTICIPANT ACKNOWLEDGMENT, AND LIABILITY RELEASE AGREEMENT

General Provisions

This Harm Reduction Agreement, Participant Acknowledgement, and Liability Release Agreement (“Agreement”) is voluntarily entered into between the undersigned individual (“Client”) and Mush Love LLC / A Human Being with Love LLC (“Provider”). This Agreement is intended to cover all activities by Client with Provider as described below. The Agreement is effective as of

the date signed below.

Client acknowledges and accepts Provider has agreed to provide certain harm reduction services including non-mental health and non-medical coaching, harm reduction services, beneficial community-based use and healing, supported use, or other related services (“Services”) related to Client’s personal use of natural medicines. The Provider will only perform services within the scope of their expertise, and consistent with the requirements of all applicable state laws. Provider is not providing any medical or mental health services.

Bona Fide Harm Reduction Services Distinguished from Licensed Facilitation

Colorado has enacted the Natural Medicine Health Act (“NMHA”), which both decriminalized the adult possession and sharing of certain natural medicines, including psilocybin mushrooms, and also created a regulated pathway to access psilocybin in licensed healing centers. It is important to understand that the work Provider is doing under this Agreement is not part of the regulated and licensed state healing center program. Provider is not acting as a state licensed psychedelic facilitator under this Agreement and Provider is not licensed by the state for this activity. Instead, the activities under this Agreement are being carried out under the decriminalization provisions of the NMHA. The decriminalization provisions of NMHA allow Provider to engage in bonafide harm reduction services and be paid for these services while concurrently sharing natural medicine for no remuneration. See Colorado Revised Statute Section 18-18-434(12)(d).

The intent of Provider is to strictly comply with Colorado law regarding these services. Thus, Provider is not engaged in the regulated provision of psychedelic facilitation through this agreement. Under the regulated portion of NMHA, the practice of facilitation includes several specific features, including: (a) regulated preparation, administration, and integration sessions in a healing center; (b) administration sessions require numerous specific plans and disclosures, including transportation plans, safety plans, and other related standard operating procedures; (c) administration sessions are governed by a use of touch agreement and only hands, feet, and shoulders can be touched; (d) healing centers are licensed locations approved by local zoning regulations; (e) there are time The intent of Provider is to strictly comply with Colorado law regarding these services. Thus, Provider is not engaged in the regulated provision of psychedelic facilitation through this agreement. Under the regulated portion of NMHA, the practice of facilitation includes several specific features, including: (a) regulated preparation, administration, and integration sessions in a healing center; (b) administration sessions require numerous specific plans and disclosures, including transportation plans, safety plans, and other related standard operating procedures; (c) administration sessions are governed by a use of touch agreement and only hands, feet, and shoulders can be touched; (d) healing centers are licensed locations approved by local zoning regulations; (e) there are time limitations on when the preparation session can occur in relation to the administration session; and (f) licensed facilitators generally have a mandatory number of hours of education, supervised practicum, and consultation regarding their work.

Numerous aspects of Provider’s services under this Agreement are distinguishable and different from the regulated NMHA program, including: (a) administration sessions are not in state licensed healing centers; (b) while certain screening measures are taken prior to your use, Provider does not use state recommended safety screen forms in providing

these services; (c) Provider does not have a time limitation on the time between preparation and administration sessions; (d) use of touch under this Agreement is potentially broader than the state regulated system as explained below; (e) Provider does not create or maintain various standard operating procedures and plans required by the state regulated system; (f) Provider’s location of services is not approved explicitly by local zoning regulations; (g) other differences that make Provider’s services distinguishable from state licensed facilitation work; and (h) Provider has not completed the state mandated practicum or consultation requirements prior to engaging in this work. The intent of Provider is to not engage in the unlicensed practice of facilitation.

No Guaranteed Results and Acknowledgement of Risks

Client understands that the Services may be transformational and, with or without the Services, create positive changes in mood, habits, and emotional state if engaged in with intention. However, Client understands and acknowledges that there are also risks associated with engaging in the Services, as discussed throughout this Agreement. Client understands that Provider cannot and does not guarantee any particular outcome from the Services. Client acknowledges that they should seek independent medical advice from a qualified professional to determine if they are medically cleared to engage in activities related to Natural Medicines. Client acknowledges that Provider is not selling or being compensated in any way for natural medicine and Client is only paying for the Provider’s Services.

Client further understands and acknowledges that the use of natural medicines, such as psilocybin, to be undertaken or performed by Client may involve risks to Client including, but not limited, to: (i) risks inherent in the nature of the psilocybin as explained below, and (ii) risks caused or complicated by any mental, physical or emotions conditions any Client may have.

Psilocybin side effects and warnings

The effects of psilocybin mushrooms include altered perception of time and space and intense changes in mood and feeling. Other possible effects of psilocybin include: euphoria, peacefulness, spiritual awakening, derealization, or the feeling that surroundings are not real, depersonalization, or a dream-like sense of being disengaged from surroundings, distorted thinking, visual alteration and distortion, such as seeing halos of light and vivid colors, dilated pupils, dizziness, drowsiness and yawning impaired concentration, muscle weakness, lack of coordination, unusual body sensations nausea and vomiting, paranoia, confusion, frightening hallucinations, and other physical, mental, and emotion effects. The effects of psilocybin vary between people, based on the user’s mental state, personality, and immediate environment.

It is particularly unsafe for people with the following conditions to take psilocybin mushrooms: (a) Psychosis. It may be unsafe for people diagnosed with psychosis, schizophrenia, bipolar 1 or 2 disorder, or similar mental health conditions to use psilocybin. (b) Heart problems. Psilocybin could be risky for people with high blood pressure or other types of heart disease. (c) Pregnancy or breastfeeding. Psilocybin’s effects on pregnancy or breastfeeding are unknown and should be avoided. (d) Medication use. Psilocybin-containing mushrooms are not recommended for people taking certain medications, which can alter the effects of hallucinogenic substances. Some examples include: Lithium (a drug treating bipolar disorder), Tricyclic antidepressants such as amitriptyline (Elavil), Haloperidol, an antipsychotic medication, Selective serotonin reuptake inhibitors such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft; see Important Safety Information), Trazodone (Desyrel; see Important Safety Information), Monoamine oxidase inhibitors, such as linezolid (Zyvox) or rasagiline (Azilect), and St. John’s Wort.

Liability Agreement and Hold Harmless Provisions

Being fully informed as to risks laid out above and in consideration of the Services, Client shall forever release, indemnify, and hold harmless Provider from any and all claims, counterclaims, damages, defenses, setoffs, recoupments, debts, demands, causes of action, suits, obligations, losses, costs, expenses, and liabilities of any nature whatsoever, in law or in equity, whether known or unknown, fixed or contingent, including but not limited to those arising from the Services and natural medicines. Client covenants not to sue Provider, or any of Provider’s principals, contractors, or agents, and waives any right of recovery, whether known or unknown, that Client may have to bring a claim or a lawsuit against Provider for any personal injury, death, damage to personal property or other injury arising from the Services and natural medicines, whether arising from a theory of any tort, including negligence, or any other theory in law or equity. This

Agreement shall inure to the benefit of any member of the Provider’s family, spouse, heirs, assigns, real property, attorneys and personal representatives. The Agreement shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. By signing below, the Client attests that they have fully and truthfully disclosed all relevant medical and mental health conditions and Provider assumes no responsibility for any claims or damages caused by the Client’s failure to disclose or misrepresentation of medical or mental health information. In no event shall Provider’s liability, if any, exceed the amount paid for the services by the Client.

Confidentiality

This Agreement and the Services provided hereunder are confidential and may not be disclosed by Client to any third party (other than the Client’s immediate family and friends) except as required by any applicable law or valid Court order. Client shall not make social media or other public posts regarding the Services.

Use of Touch

There are two types of “touch” considered during the Services, safety and support. Regarding touch for safety: If there is an issue in which the Provider determines that touch is required for your safety, you acknowledge and consent to being touched, e.g., holding your arm to avoid falling, or to provide support to walk to the restroom. Regarding touch for support: If, during the Services, a supportive touch, e.g., placing a hand on your shoulder or forearm, appears that it could be helpful, the Provider will offer this supportive touch to you. You may verbally or non-verbally (shake your head yes or no) decline this offer or accept at any time during the Services. You may also change your mind. For example, if you request or prefer supportive touch at one point in the Services, you may decline to do so later. Before the Services, the Provider will engage you in a discussion about your preferences for supportive touch during your session, including but not limited the differences between touching for safety and for support, your choice for engaging in supportive touch and your right to change your mind.

Miscellaneous

Mediation/Arbitration. Prior to initiating any action under this Agreement, the Parties agree to engage in mediation to resolve any disputes. For any dispute not resolved by mediation, any remaining dispute, claim, interpretation, controversy, or issues of public policy arising out of relating to this Agreement, including the determination of the scope or applicability of this Section, will be determined exclusively by mandatory binding arbitration held in Denver, Colorado, and will be governed exclusively by the Colorado Revised Arbitration Act, §§ 13-22-201, et seq., C.R.S. (the “CRAA”). The Parties waive (i) any right of removal to the United States federal courts and (ii) any right in the United States federal courts to compel arbitration, to confirm any arbitration award or order, or to seek any aid or assistance of any kind. If either party brings an action to enforce the provisions of this Agreement and is the substantially prevailing party in any action, the substantially prevailing party will be entitled to recover its reasonable attorneys’ fees and expenses incurred in such action.

Medical Treatment. Client hereby consent to receive medical treatment which may be deemed advisable in the event of a medical emergency, injury, accident, and/or illness during the Services.

No Third-Party Beneficiaries. The terms and provisions of this Agreement are intended solely for the benefit of the Parties and their respective successors or permitted assigns, and it is not the intention of the Parties to confer third-party beneficiary rights upon any other Person.

Entire Agreement. This Agreement supersedes all prior discussions and agreements between the Parties and/or their Affiliates with respect to the subject matter hereof and contains the sole and entire agreement between the Parties and their Affiliates with respect to the subject matter hereof.

Waiver. Any term or condition of this Agreement may be waived at any time by the Party that is entitled to the benefit thereof, but no such waiver will be effective unless set forth in a written instrument duly executed by or on behalf of the Party waiving the term or condition. No waiver by any Party of any term or condition of this Agreement, in any one or more instances, will be deemed to be or construed as a waiver of the same or any other term or condition of this Agreement on any future occasion. All remedies, either under this Agreement or by Law, are cumulative and not alternative.

Succession and Assignment. This Agreement is binding upon and will inure to the benefit of the Parties and their successors and assigns. No Party may assign this Agreement or any of its rights, interests, or obligations hereunder.

Governing Law. This Agreement is governed by and construed and enforced in accordance with the laws of the State of Colorado, without giving effect to any conflict or choice of law provision that would result in imposition of another state’s law. THE PARTIES ACKNOWLEDGE THAT COLORADO HAS ENACTED CERTAIN LEGISLATION REGARDING NATURAL MEDICINES UNDER NMHA AND THE POSSESSION, SALE, MANUFACTURE, AND CULTIVATION OF NATURAL MEDICINES IS ILLEGAL UNDER FEDERAL LAW. THE PARTIES WAIVE ANY DEFENSES BASED UPON INVALIDITY OF CONTRACTS FOR PUBLIC POLICY REASONS AND/OR THE SUBSTANCE OF THE CONTRACT VIOLATING FEDERAL LAW.

Client acknowledges that he or she has read this Agreement fully and understands it, including its binding legal consequences, intends to be bound by this Agreement, and is signing this Agreement freely and voluntarily.

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