4 day – San Pedro and Ayahuasca – Weekend Journey July 9th -12th, 2026

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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.
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Medical Issues *	Enter "none" if you have no issues
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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.
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Do you grant us permission to use photos of you taken during your stay for our social media and marketing purposes? *	Yes No
Payments do not include the cost of plant medicines. *	I understand that payments made through Retreat Guru do not include the cost of: plant medicine, psychedelics or similar products. There will be no additional charges for this retreat.Supplementary Products Exclusion: Participants acknowledge and agree that these Fees presented and payable pertain solely to Services and Offerings, and will not include the cost of any plant-medicines or similar products (collectively, "Supplementary Products") which may be provided, offered, or distributed by a Commercial User, or any other party, in connection with Services or Offerings. Retreat Guru shall bear no responsibility or liability in connection with any provision, offering, or distribution of Supplementary Products, and is not a party thereto. All capitalized terms used herein shall carry the same meaning as assigned to them in Retreat Guru's Terms of Service.

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

4 day - San Pedro and Ayahuasca - Weekend Journey July 9th -12th, 2026

1 Welcome

2 Price

3 People in your group

4 Optional Items

5 Participant Info

6 Security Check

7 Payment