6 Weeks Ayahuasca Journey

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By WhatsApp +51 997 405 335
By E-Mail contact@lighthouseayahuasca.org

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WhatsApp Communication Requirement
⚡⚡⚡

To ensure smooth and timely communication before, during, and throughout your retreat, our team communicates with all guests exclusively through WhatsApp.

Please provide your mobile phone number, including your country code, and ensure that WhatsApp is installed on that number.

If you do not already have WhatsApp, please install it immediately after completing your registration so we can send you important updates, arrival information, and answer any questions you may have before your retreat begins.

Once your retreat has concluded, you are welcome to remove WhatsApp if you no longer wish to use it.

Thank you for your understanding and cooperation. We look forward to welcoming you!⚡⚡

Your journey is about to begin. Before we welcome you, we kindly ask you to share a few details with us. Everything you entrust to us will remain completely confidential and will be received with care, respect, and intention. Your responses allow us to create a space where you can feel supported, safe, and deeply cared for throughout your experience. 🥰

* These fields are required

1 Welcome!

2 Choose the dates of your stay

3 Accomodation

***NOTE*** - The remaining balance of the payment is due as a ***Cash Payment (USD)*** once you arrive on Monday and register at the center.

Select an option*

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Single/Double Room

We keep a fine balance when it comes to connecting you to Nature. On the one hand, we want to...

Guests in Room:
In rooms

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$9,000

$9,000

$9,000
Single/Double Room
We keep a fine balance when it comes to connecting you to Nature. On the one hand, we want to provide you with enough comfort and “civilized” pleasures, but on the other hand, we want to immerse you in the Jungle and its habitats. Be sure that by the Jungle standards, your accommodation is luxurious beyond belief 🙈(more info). In your room you will have a comfortable single bed ( or two beds if you have a partner), Mosquito screening, Fresh linen, a built-in bathroom with a shower, fan, satellite Wi-Fi, charging sockets, and Potable water.

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4 People in your group

5 Optional Medicine

6 Your Information

Phone 📞	⚡⚡⚡WhatsApp Communication Requirement⚡⚡⚡ To ensure smooth and timely communication before, during, and throughout your retreat, our team communicates with all guests exclusively through WhatsApp. Please provide your mobile phone number, including your country code, and ensure that WhatsApp is installed on that number.
Your Phisical Health 💪	Low Blood Pressure High Blood Pressure Heart Surgery Heart Attack Irregular Heartbeat Chest Pain Circulation Problems Diabetes Meningitis Migraines Epilepsy Hyperthyroidism Hypothyroidism HIV/AIDS Asthma Cancer or Tumor Obesity Ulcer Chronic Pain Fibromyalgia Arthritis Aneurysm Neurological Disease Infectious Disease Gynaecological Condition Stroke Head Injury (check the boxes that apply to you)
Your Mental Health 🧠	Schizophrenia Depression Paranoia Panic attacks Obsessive Compulsive Disorder Suicidal Thoughts Post-Traumatic Stress Disorder Psychosis Bipolar Disorder Chronic Anxiety Eating Disorder Autism Asperger’s Borderline Personality Disorder Depersonalisation Disorder Multiple Personality Disorder Self-Harm (check the boxes that apply to you)
Medications you are currently taking 💊	Please list all the medications you are taking. If no medications are taken, type "none" *Our team cannot provide medical guidance for any type of medication. Please consult your doctor about stopping your current medication at least two weeks prior the ceremony.
Dietary Preferences🥩/🍃 *	We do adhere to the Ayahuasca diet but if you have any preferences, let us know!
Allergies🤧 *	This includes food, substances, animals, etc. If you have no allergies, please type "none"
Other Psychedelic Substances🍄	Please describe the substances/dosages and the effetcs you have experienced before.
Your Intention 🤔	Please describe what you expect from the Ayahuasca. Expecting nothing is also an expectation :D
How did you hear about us? 👂 *	🙏
I take full responsibility for my decision of doing Ayahuasca and acknowledge all the risks. *	I take full responsibility for providing truthful information about my phisical and mental health, for my decision of doing Ayahuasca and agnowledge all the risks. I understand that Ayahuasca can be harmful if taken irresposibly and I carefully studied and weighed all the benefits and side effects of Ayahuasca.

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7 Payment

Sub Total	$0

Donations	$0

Taxes	$0

Deposit	$0

Due Now	$0 $0

Remaining Balance	$0

By WhatsApp +51 997 405 335
By E-Mail contact@lighthouseayahuasca.org

⚡⚡⚡
WhatsApp Communication Requirement
⚡⚡⚡

To ensure smooth and timely communication before, during, and throughout your retreat, our team communicates with all guests exclusively through WhatsApp.

Please provide your mobile phone number, including your country code, and ensure that WhatsApp is installed on that number.

Once your retreat has concluded, you are welcome to remove WhatsApp if you no longer wish to use it.

Thank you for your understanding and cooperation. We look forward to welcoming you!⚡⚡

Guest 1		First Name* Last Name* Email 📬*
Guest 1		First Name* Last Name* Email 📬*

1 Welcome!

2 Choose the dates of your stay

3 Accomodation

Select an option*

Single/Double Room

4 People in your group

5 Optional Medicine

6 Your Information

7 Payment