Apply for a Retreat

To join us for an Ayahuasca retreat, please fill out this 4-step application and we will respond to you at the earliest possible.

The information shared in this application will be kept private and confidential.

For your own safety please provide accurate and truthful information.

Fields marked with * must be filled out, if your submission fails please look for the error message in the form.

Step 1: Personal Information

Full Name *

Address *

Country of Residence *

Country of Citizenship *

Phone Number *

Email *

Gender *

Date of birth *

Any social media or public profile link *

Occupation *

Emergency contact name and phone number *

Step 2: Retreat Information

Why do you want to come to this retreat? *

Do you have any previous experience with shamanic plants, with shamans, or in ayahuasca retreats? When and Where?

Food allergies and restrictions

Step 3: Health Information

How do you handle crises? Explain: *

Describe personal and/or family history of depression, psychological disorders or imbalances, suicidal thoughts. *

Are you currently taking any kind of medication and/or supplements? *

When was the last time you took a medicine or supplement and for what? *

Do you or a family member have a history with substances or addictions? * Explain:

Have you ever been hospitalized? Why and when? *

Health insurance for travel - company and policy number:

Step 4: Reservation Information

Date *

What type of accommodation do you prefer? *
Two Person Shared BungalowThree Person Shared BungalowFive Person Mixed DormitoryPrivate Bungalow

How did you learn about us? *

Any other comments?

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Note: All form details are saved when you click a button above.
If the application was not submitted successfully it will be saved on our server and we will contact you at the email address listed.
Press Next to proceed to the next step and Send on the last step to submit.

Upcoming Retreats

  • Oct  3 — Oct 11
  • Nov  15 — Nov 25
  • Dec  13 — Dec 21
  • Jan  9 — Jan 19
  • Feb  20 — Feb 28

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