Dreamwalkers – Intimate Ayahuasca Retreat w/Erick Godsey| Kinkara, Costa Rica

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Have you ever been diagnosed with any physical illnesses? Please explain in detail.	Enter "none" if you have no issues
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Terms and Conditions	I have read and accept the terms and conditions of Anam Cara's payment and booking policy. All retreat deposits are nonrefundable in order to reserve your space at the venue. Upon receiving your application, we will closely review your medical history and follow up via email to let you know you have been approved. Once approved, you can move forward with your travel plans. If upon reviewing your medical application we find that working with Ayahuasca is unsafe or not a good fit for you due to safety or health risks, we will refund your deposit and kindly deny your application. All medical and health information MUST BE DISCLOSED at the time of application, not later on. After paying your retreat deposit, your remaining balance is due in cash USD on day 1 of your retreat. If for any reason you do not show up for the retreat or you cancel within 60 days and we cannot accommodate a date change, your credit card on file will be charged your remaining retreat balance. In case of emergencies please notify us with as much time as possible. In some cases if given more than 60 days notice, we can do our best to transfer your deposit to another retreat date. We will always try our best to work with you but last minute changes are nearly impossible for us. Cancelations made 60 days within the retreat date window are not refundable or transferable.
Have you ever been diagnosed with a mental health condition? (This will not disqualify you from being eligible for plant medicine, we just would like to know).
Have you ever had a seizure?
Have you ever been diagnosed or experienced any heart conditions or issues?
Has anyone in your immediate family ever been diagnosed with a mental health condition?
Has anyone in your immediate family ever been diagnosed with any severe heart or brain conditions?
Please list any medications you have taken in the past and how long you've been off of them.
Please list any medications you are currently taking including their name, frequency, and dosage.
Please share your history with any drug and alcohol usage and/or addiction.
Please share any experience you've had with psychedelics or plant medicines.
Please share a bit with us about your intentions for coming and working with plant medicine.
I understand that I will pay my remaining balance in cash upon arrival to the retreat.	Yes No
Have you ever been diagnosed with any mental illnesses? Please explain in detail.
If you heard about us through a friend, please tell us their name.
I have read and understand the registration process	After submitting this form you will be redirected to our "deposit payment" page where you can find options to pay your $2500 USD deposit. This deposit is required to reserve your space on this retreat. Your deposit is required for the application to be processed. Payment Options: No Fee, deposit can be sent via Zelle. With a fee, payment can be sent stripe link to pay via credit/debit card. You will be redirected to the the deposit payment page after submitting this form. Once your deposit has been received, your application will be reviewed and eventually confirmed. We will reach out to you if you have any medical issues or take any medications that are contraindicated. Please do not begin making travel plans before your application has been approved by our team.
Why you feel called to attend this specific retreat?
What you are seeking from the experience?
How you intend to integrate the work after the retreat?
Payments do not include the cost of plant medicines. *	I understand that payments made through Retreat Guru do not include the cost of: plant medicine, psychedelics or similar products. There will be no additional charges for this retreat.Supplementary Products Exclusion: Participants acknowledge and agree that these Fees presented and payable pertain solely to Services and Offerings, and will not include the cost of any plant-medicines or similar products (collectively, "Supplementary Products") which may be provided, offered, or distributed by a Commercial User, or any other party, in connection with Services or Offerings. Retreat Guru shall bear no responsibility or liability in connection with any provision, offering, or distribution of Supplementary Products, and is not a party thereto. All capitalized terms used herein shall carry the same meaning as assigned to them in Retreat Guru's Terms of Service.

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Guest 1		First Name* Last Name* Email*

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