Ayahuasca Shaman Retreat Booking Form

Thank you for applying for an ayahuasca retreat at the Ayahuasca Shaman Retreat! To begin our registration process, please fill out this form, and we will try to get back to you within 24 hours with any follow up questions we may have.

All information provided will be kept private and confidential.

For your own safety and well being, it is important the medical background and medication information be truthful and accurate. Certain conditions and medications have potentially serious risks when combined with ayahuasca.

Name

First

Last

Date of birth

Gender

Email Address

Retreat Conditions Booking

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Retreat Program

Retreat Date

Dietary Preference

Pescatarian
Vegan
Vegetarian
None

Diet Restrictions

Reason for Retreat

Medical History Background

Medical Conditions

Medications

Special Needs

Emergency Contact

Emergency Contact Email

Medical Documents

Booking Agreement

I agree NOT to book flights or make travel plans until my application has been approved. I understand that my registration is not confirmed until my application has been reviewed and approved by the Ayahuasca Shaman Retreat AND I have paid my booking.

Payment Agreement

I understand that a minimum 50% deposit is required to confirm my booking or that I may pay the full retreat cost if I prefer. I understand full payment must be made at least 2 weeks prior to the start of the retreat to guarantee my space.

Cancelation Terms

I understand that if I cancel my registration more than 4 weeks prior to the start of the program I may transfer to a different program or transfer my payment to personal credit to be used within the next 2 years. I understand that I will not receive a refund. I understand that if I cancel my registration within 4 weeks of the start of the program I may only transfer to a different program or transfer my payment to personal credit to be used in the next 2 years if the Ayahuasca Shaman Retreat can fill my place in the program

Terms & Conditions

I accept the full terms and conditions attest that all information is accurate and accept full legal & personal liability for joining this retreat protecting Ayahuasca Shaman Retreat from all legal liability.

Ayahuasca Shaman Retreat Booking Form

Choose the Transformational Journey That Speaks to Your Soul

Treatments

Courses

Useful Links

Contacts

WhatsApp Only
048-889-7634

Ayahuasca Shaman Retreat Booking Form

Treatments

Courses

Useful Links

Contacts

WhatsApp Only 048-889-7634

WhatsApp Only
048-889-7634