Before you fill the application be aware that we, THE ORGANIZERS, will respect your privacy and will treat as confidential any information (medical or otherwise) about you. We, THE ORGANIZERS, will not disclose it to any person other than our employees and contractors without your consent.
Email address *
What is your Full Name? *
Your answer
What is your email address? *
Your answer
Date of Birth *
Gender *
What is your country of residence? *
Your answer
What your phone number? *
Your answer
Please provide a Emergency contact name *
Your answer
Also, provide the phone number and email of your Emergency Contact *
Your answer
Please inform us of any physical medical conditions you have had in the past or are presently dealing with. Please list any serious injuries or surgeries. *
Your answer
Please list any medications, natural supplements or recreational drugs you are taking. *
Your answer
Please list any allergies to medications, food or environmental substances you have. *
Your answer
Please inform us of any past or current conditions of depression, anxiety or other psychological conditions. Please share any related details. *
Your answer
Have you previously participated in any Hape Ceremony or Master Medicines rituals? Please give any details or outcomes relating to your experience. *
Your answer
What are your intentions for working with the hape? What makes you want to do this retreat? *
Your answer
Is there any question, requirement or suggestion? *
Your answer
About Food
Are you Vegetarian? *
Are you Vegan? *
Please provide us the name or the list of the food you DON”T eat or like to consume *
Your answer
Do you have any food intolerance? *
If any intolerance please provide us with the name or the list of the food you are intolerant *
Your answer
Is there any question, requirement or suggestion in reference to food? *
Your answer
Liability Waiver
Liability Waiver
I herby acknowledge that I have voluntarily applied to participate in a retreat "Hape Journey Uki" I have chosen Gymea Retreat, Uki, NSW 2484, Australia from 15th until 19th May 2019. I understand that by signing this document I accept and assume responsibility for any and all risks, whether or not specifically itemized herein, to include travel to and from activities and facilities. I hereby irrevocably release THE ORGANIZERS, its employees, associates, board members, and property owners, family of the same and any organization that THE ORGANIZERS represents or contracts with. They shall be held harmless and blameless in the event of any mishap. I understand that the retreat and recreation activities which are a part of the retreats in Uki, Australia may involve some risk of injury or death from various hazards, both obvious and obscure, including but not limited to, injury by acts of other group participants, falling, being struck by falling objects, fauna and flora, and other risks or occurrences not set forth in this agreement. I am prepared and aware of the possibilities of risks and will not look to any entity or individual nor hold them responsible for my wellbeing or the protection from such risks whether or not those risks are known or unknown by those organizations or individuals.

I am also aware that medical services or facilities may not be readily available or accessible during some or all of the time that I am participating in the retreat. I agree that THE ORGANIZERS, its principals, guides and agents are not liable for the adequacy or availability of any equipment or supplies that may be provided in conjunction with the retreat, or for the adequacy or availability of any first aid or medical care, or the negligent provision of first aid or medical care by it or by its guides or agents, participants, or by any physician, emergency care facility or any other person.

I agree to disclose in my application all truthful information relating to my medical history, current medications and dosages, vitamins or supplements being taken as well as allergies to medications or environmental substances. I agree to disclose any changes made in my dosages of medications to the organizers before the retreat begins. If I am on an anti-depressant medication or any substance that is contraindicated with the use of plant medicines, I agree to discontinue it’s use no less then three weeks before the retreat begins.

I further agree to respect the person and property of others, and to abide by the rules and TERMS AND CONDITIONS of the Retreat. I understand that violation of those rules and TERMS AND CONDITIONS may lead to my expulsion from the retreat and facility without refund.

I consent to the use by THE ORGANIZERS any videotape, photograph, slide, audiotape, or any other visual or audio reproduction in which I may appear. I understand that these materials are being used for promotion of various retreats by and for THE ORGANIZERS. Such promotional activities extend to recruitment, fund-raising, advocacy, etc. I release THE ORGANIZERS from any liability connected with the use of my picture or voice recording as part of any of the above or similar activities.
If, because of my negligence or deliberate act or omission, any equipment, premises, car, public or private property or land is damaged, domestic or wild animal is injured or killed, flora is damaged or destroyed, or any person is injured, harmed or killed, then I am liable for any repair, replacement, medical and other associated costs.


Terms and Conditions
Cancellation by THE ORGANIZERS: THE ORGANIZERS reserve the right to cancel a trip at any time before departure, due to terrorism, natural disasters, political instability or other external events it is not viable for us to operate the planned itinerary. If we cancel a retreat you may choose between us applying the amounts paid toward an alternative retreat or receiving a full refund. We are not responsible for any incidental expenses that you may have incurred as a result of your booking such as visas, vaccinations or non-refundable flights.
Liability: We contract with various groups and individuals to assist in the running of our trips. We are not responsible for any act or omissions by a third party. We always recommend all participants to have full travel insurance including cancellation. You acknowledge that the nature of the trip is adventurous and participation involves a degree of personal risk, as you will be visiting places where the political, health, cultural and geographical attributes may present dangers and physical challenges greater than those present in our daily lives.
Change of Itinerary: While we endeavour to operate all trips as described we reserve the right to change the trip itinerary. Before departure: If we make a major change we will inform you as soon as reasonably possible if there is time before departure. After departure: We reserve the right to change an itinerary after departure due to any circumstances. Please note we are not responsible for any incidental expenses that may be incurred as a result of the change of itinerary such as visas, vaccinations or non-refundable flights.
Flexibility: Due to the nature of this trip we ask you to consider the need for flexibility. We reserve the right to make changes to route, schedule, amenities and transport without prior notice.
Refunds: If THE PARTICIPANT cancels for any reason, including, but not limited to, the refusal or inability to pay the Full Price of the tour, after having placed a deposit of US$500, the Client will incur cancellation charges of US$ 590, 10-30 days 75% total cost of retreat, 10 days 100% of total retreat cost.
Respect: You are asked to be respectful and mindful in every action and interaction regarding any person involved or not in the retreat (general public, the organizers, contractors, servers, volunteers, cleaners, cooks, other participants, etc).
You are required to respect the processes and activities in the retreat, including respect of rules and codes of ceremonies and circles. Also, to respect your own process and the process of other participants.
Diversity: As we are working with diverse people from different backgrounds we see this retreat as a space of harmonious integration and healing, so, we invite you to celebrate diversity.
We will provide healthy meals, vegetarian and non-vegetarian menus, during the retreat; we invite you to be open and considerate about the food choice of others participants or not of the retreat, letting go judgement and embracing diversity.
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