Section I

Personal Information

First Name *

Last Name *

Date of Birth *

Country of Residence *

E-mail Address *

Phone (with country code) *

Emergency Contact

Full Name

Relationship

Phone (with country code)

Section II

Your Intention & Inner Landscape

These questions help us understand where you are in your life and how to hold space for you most effectively. Please be as specific and honest as you can — thoughtful, detailed responses are deeply valued.

What is your primary intention for this ceremony?

What has been the most significant challenge in your life over the past year?

Are you currently moving through grief, significant loss, or major life transition?

What has been the most transformative moment of your life so far?

What do you fear?

What brings you joy?

What is your greatest aspiration for your life?

Do you embrace or practice a spiritual path, tradition, or religion?

What does the word "ceremony" or "sacred ritual" mean to you personally?

Experience with non-ordinary states of consciousness

Experience with therapy, coaching, or self-exploration

Why did you choose to do this work specifically with us?

Section III

Life Situation & Integration Capacity

Are you in a stable life situation with support systems available?

Is there anything significant happening in your outer life right now?

Do you have any behavioral or substance addictions, past or present?

Preparation commitment

In the 30 days before the ceremony, are you willing to minimise alcohol, cannabis, stimulants, and recreational substances to support your sensitivity and preparation?

Yes Yes, and I have questions No / unsure — I'd like to talk

Section IV

Health & Medical Screening

Your safety is our highest priority. Please answer every question fully and honestly. If you are unsure, it is always better to disclose — we will assess together.

Describe your general state of physical health

Have you visited a healthcare provider for any health issue in the past year?

Yes No

Are you currently taking ANY medications?

If none, please write "None."

If a medication may require adjustment prior to the ceremony, are you willing to consult your doctor?

Yes No Not applicable

We can provide a preparation document for your doctor if helpful.

Any known allergies or severe food sensitivities?

Are you pregnant, breastfeeding, or could you be pregnant?

Yes No Possibly

Section V

Travel & Physical Readiness

Peru involves travel, altitude (Cusco sits at ~3,400m), and extended time in nature. These questions help us prepare well for you.

Have you travelled in developing countries before?

Travel health & vaccinations

Physical fitness & mobility

Special assistance, accessibility, or dietary needs

Section VI

Practical & Logistical

How did you hear about this retreat?

Personal recommendation Website / social media Other

After confirmation, I would like to:

Deposit

€800

to secure my place

Pay in Full

€2,400

Early Bird

Pay in Full

€2,600

Standard

Section VII

Anything Else

Is there anything else you want or need us to know?

Application Questionnaire