Pre-ceremony declaration
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Pre-ceremony declaration

All participants are to complete this form.
Please complete this form before arriving at the venue.
There are 6 questions in this survey.
Please complete this form with as much detail as possible.
(This question is mandatory)

Please fill out your contact details below

(This question is mandatory)

Are you currently receiving therapy or attending any kind of support group?

(This question is mandatory)

Are you currently taking any prescribed or other medication?

(This question is mandatory)

Is there anything else about your current physical or emotional state we should know about?

(This question is mandatory)

In one sentence or a short paragraph, please describe your intention for this upcoming ceremony with us. This helps us to understand your intent and how best to assist you in the ceremony.

(This question is mandatory)
By submitting this form, I acknowledge that I have completed and understood the Ayahuasca ceremony application and read and understood the info on the recommended Ayahuasca Diet
By submitting this form, I declare that I have answered all questions truthfully and have understood the content of the information given. I accept full responsibility for my participation in this ceremony, I understand enough about the journey which I am about to embark upon, from communication with the facilitators and people who have participated previously. I declare that the choice to participate in this ceremony is completely at my own free will and that I have not been convinced or forced by any other person to attend.
 
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