Name *

First Name

Last Name

Phone

(###)

###

####

Statement of Belief *

Primordia Temple is a nonprofit spiritual organization rooted in earth-based practices, reverence for nature, and mindful personal growth. I am joining as a member in alignment with its values of healing, reflection, integration, and ecological stewardship.

I affirm my intention to join the Temple in good faith and alignment with its purpose.

I understand that membership is voluntary and does not entitle me to any physical goods or services.

Sacrement Clarification *

Primordia Temple does not provide, distribute, or facilitate access to controlled substances. While the Temple honors the sacramental use of entheogens as part of many earth-based spiritual paths, individual members are solely responsible for their personal practices.

I understand and accept that any spiritual practices I choose to engage in are of my own will and at my own discretion.

Liability Waiver *

By joining the Temple, I understand that all teachings, resources, and community gatherings are offered for spiritual and educational purposes only. I acknowledge that the Temple does not offer medical, legal, or psychological advice, and that I am responsible for my own well-being and decisions. I release Primordia Temple and its stewards from any liability related to how I choose to engage with its teachings or community.”

I have read and understand the above, and I accept personal responsibility for how I engage with the Temple’s offerings.

Privacy & Confidentiality *

All member information is confidential and will not be sold, shared, or distributed. Members are expected to treat other members’ information and experiences with the same discretion and respect.

I understand and accept that any spiritual practices I choose to engage in are of my own will and at my own discretion.

Date *

MM

DD

YYYY