Parign Hak & AWD- Registration Form
Please be as detailed as possible. We also request that you read all of the information on the "Registration and Admission" section of our website before applying.
Full Name *
Email *
Please Confirm Email *
Date of Birth *
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What is/are your pronoun(s)? *
Country *
On what dates published on our website would you like to visit? *
What is your experience with Ayahuasca/Ayahuasca retreats if any? *
Have you worked with other Plant Teachers / Psychedelic Medicines before? If so, please elaborate. *
Are you planning on using marijuana within 6 weeks of your preferred dates? *
Are you planning to use Wachuma (San Pedro) or any other mescaline containing plants during eight days prior to and/or after your preferred dates? *
Are you currently taking any drugs, medication, herbs or supplements? If so, please outline what, how much and how often (please be as detailed as possible) *
Women: Are you pregnant or breastfeeding? *
Please describe any medical conditions, diseases or injuries, past and present. This includes psychological as well as physical ailments. *
Do you have any family history of mental health conditions, such as ADHD, OCD, Depression, Anxiety or ASD? If so, please explain. *
Do you have any specific dietary needs, allergies, intolerances, vegan, vegetarian etc? *
What other spiritual practices do you engage in, if any? *
Do you have any fears or anxieties about attending this retreat? If so, please elaborate. *
What is it about our retreat that most appeals to you? *
What are some of your deepest hurts that you would like to address? *
What are your personal goals for this retreat? *
How did you hear about us? *
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Additional Notes - Is there anything else you would like to mention?
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