3 day – San Pedro and Ayahuasca – Weekend Journey January 17th-19th

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1 Welcome

2 Price

3 Optional Items

Andean Limpia Cleansing

Limpias are rituals of the Andean people used for energy cleansing with medicinal plants. We offer this service in deep connection with this ancestral tradition. The Cleanse of fire energizes, balances, and offers us a liberation to continue with our spiritual path. The physical body and its energetic charge are cleansed using spirits macerated with plants such as ginger, cinnamon, purslane, rue, and using special stones to absorb the charges.

$40.00

Kambo (Single Session)

This is the serum of a tree frog (Phyllomedusa Bicolor) that lives in Brazil's Amazon rain forest. It is used to liberate oneself of the "panema" (original tribes give this name to the negative energies attached to the physical body). It is a cleansing and health ritual for the body and a powerful medicine for our immune system. It has been found that Kambo has nine bioactive peptides that produce a potent effect in the gastrointestinal muscles, gastric and pancreatic secretions, blood circulation, and stimulation of the adrenal cortex and pituitary gland. This medicine works with the physical, mental/emotional, and spiritual bodies.

$50.00

Kambo Package (3 sessions)

3 Kambo sessions at a discounted price.

$120.00

Extra Ayahuasca Ceremony

We offer an extra, optional Ayahuasca Ceremony on Day 9 of the Retreat.

$120.00

Massage

A one hour massage from a qualified, female massage therapist.

$60.00

Transportation to Hayulima

We do offer pickup and drop-off for retreat participants, which is included on the price. If you want to be picked up and brought to Hayulima after you land or on a different day, we offer a private ride for a $70 fee. Hayulima is located 2.5 hours from Quito Airport. Please choose this option if you are not going take 10:00AM ride on Day 1 of your retreat or if you are participation in other program. Transportation refunds can be applied only 5 days before the settle pick up date.

$70.00

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4 Participant Info

Address *
Address 2
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Email newsletter	Please send me the email newsletter
Comments or Special Needs
Country *
Gender *
Birth Date *
Age *
Arrival Date *	If you don't know your arrival date you can email us when you know. The pick up included in your price is at 10:00 AM on Day 1 of the Retreat at the Quito Airport. We can also pick you up one hour after you land if you wish. The cost for this ride is $70 as we are 2.5 hours away from Quito.
Flight Arrival Information	If you know your Flight Number and information, please enter it here. Alternatively you can email it us once you know it.
Dietary Restrictions *	Do you have any dietary restrictions or allergies that we need to know about.
What are looking to achieve during your retreat? *	Please let us know why you are coming. What are looking to heal while you are here? Anything you share is kept confidential.
Terms and Conditions *	I accept the terms and conditions.I accept full responsibility for participating in a retreat and in the ceremonies at Hayulima Sanctuary. I have answered all the medical questions on this form completely and honestly. I understand and agree that I can be excluded from participation in a retreat or ceremony at the discretion of the facilitator or Shaman. I agree to respect all individuals at all times. I understand that I can opt out of any ceremony before a ceremony starts but cannot leave a ceremony until it is over. I understand that these sacred medicines are not a substitute for medical, psychiatric or psychotherapeutic treatments but may complement a therapeutic process and facilitate personal development.
Waiver of Liability Relating to Coronavirus/COVID-19 *	I accept the terms and conditions.The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life threatening illness and even death. Hayulima cannot prevent you from becoming exposed to, contrac0ng, or spreading COVID-19 while utilizing Hayulima’s services or premises. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize Hayulima’s services and/or enter onto Hayulima’s premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19. ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself in order to utilize Hayulima’s services and enter Hayulima’s premises. These services are of such value to me that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize Hayulimas’s services and premises in. WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against Hayulima and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to u0 utilizing Hayulima’s services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.
Emergency Contact Info *
Medical Issues *	Enter "none" if you have no issues
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5 Health & Medical Questions

Do you have any medical issues that we should know about? (asthma, diabetes, epilepsy etc) *
Have you had or do you currently have any mental illness that we should know about? (Bipolar, schizophrenia, dementia)? *
Do you have any heart conditions? Please explain *
Please list any antidepressants or antipsychotic medications that you currently take? *	You must be off these medications completely for at least a full two weeks before the retreat.
Are you taking any other medications? *	There are medications that should not be taken with the medicine so it is good for us to know.

6 Emergency Contact Information

The people you provide here are only contacted in an emergency.

First Emergency Contact, First Name and Last Name * *
First Emergency Contact - Relation to you *
First Emergency Contact - Phone Number *
First Emergency Contact - Email Address *
Address
Address 2
City
State/Prov.
Zip/Postal
Country
Second Emergency Contact, First Name and Last Name *
Second Emergency Contact - Relation to you *	Relation to you
Second Emergency Contact - Phone Number *
Second Emergency Contact - Email Address *
Address
Address 2
City
State/Prov.
Zip/Postal
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Passport or ID number *
Do you grant us permission to use photos of you taken during your stay for our social media and marketing purposes? *	Yes No

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3 day - San Pedro and Ayahuasca - Weekend Journey January 17th-19th

1 Welcome

2 Price

3 Optional Items

4 Participant Info

5 Health & Medical Questions

6 Emergency Contact Information

7 Payment