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Shipibo Ayahuasca Ceremonies with Maestro Niwe Sina & Isakea from Pucallpa Perú - Abuela Tree Sanctuary

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Shipibo Ayahuasca Ceremonies with Maestro Niwe Sina & Isakea from Pucallpa Perú – Abuela Tree Sanctuary

November 28, 2024

Retreat Guru is the online booking agent for Kawoq Forest.

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1 Price

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$250.00 – Ceremony

Number of Guests:

2 People in your group

Guest 1		First Name* Last Name* Email*
Guest 1		First Name* Last Name* Email*

3 Participant Info

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First Name *
Last Name *
Email *
Phone *
Email newsletter	Please send me the email newsletter
Discount code
Emergency Contact	Include name, phone number, or best way to contact them.
Please state your personal reason for attending. *
If you have attended this type of session before, please let us know where you participated and how many times. *
You agree to the terms and conditions. *	The undersigned hereby seeks to participate in the activity listed above and understands that the Centre desires to ensure the safety of all participants. In order to assist facilitators in this regard, I agree to complete the Confidential Medical history form provided. I am assured that the information provided will remain strictly confidential and will serve only as a guide in determining the appropriateness of my participation in the work and in meeting my needs before, during and after the ceremony. I have been informed of the nature of those works, the needed preparations and the rules of the ceremonies. I commit myself to stay in the Centre until the end of the ceremony and to respect the directives given by the guardians named by the Facilitator of the session.
To assist us, please check the boxes that apply to your current or past condition. Your responses will remain strictly confidential. *	Cardiovascular disease, including heart attacks High blood pressure Recent surgery Recent or current infectious or communicable diseases Pregnant Been hospitalized within the last 2 years Have a psychiatric diagnosis Been hospitalized for psychiatric reasons Currently in therapy or involved in a type of support group Have been in counseling with a psychiatrist, psychologist, or other counselor within the past two years Use medication None
Please elaborate on anything that was checked YES in the previous question. *
Is there anything else about your health status of which we should be aware of? *
Reason for counseling (if applicable)	Academic Suicide Depression Substance Abuse Career Divorce Family issues Other
You agree to the following. *	The information provided above is a complete and accurate statement of the physical and psychological factors which may affect my participation in the activities listed above. I realize that failure to disclose such information could result in serious harm to me and/or fellow participants and I agree to indemnify and hold harmless the Center if all relevant information is not disclosed. I also agree to notify the facilitators should there be any changes in my health status. I hereby confirm that I have read and understood the above information and have answered all the questions completely and honestly and have not withheld any information. My general health, as far as I am aware, is good.

4 Payment

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	Retreat Guru is the online booking agent for Kawoq Forest. Charges will appear on your bill as "Retreat Guru"