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Movement + Music + Medicine 2025 Costa Rica Registration
PLEASE NOTE: all information is STRICTLY CONFIDENTIAL and is to ensure the safety of all participants. Please be honest, taking full personal responsibility for your physical and spiritual well-being.
Step 1: Let's start with your personal details
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What country do you live in?
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Emergency Contact
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Have you worked with any of the following medicines before?
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Have you worked with any of the following medicines before?
Is there a history of trauma or mental illness in your family lineage?
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PLEASE NOTE that in certain cases working with Ayahuasca can carry health risks. By coming to a Retreat, you are declaring that you are in a physical and mental condition appropriate to the activities, and agree that you participate at your own risk and that we cannot accept liability for any accident or injury.
If you have any heart, liver or kidney, or other serious medical problems, please inform us immediately. Working with the Plant Medicines requires observation. In order to participate, please confirm if any of the below is applicable:
- Heart diseases or heart problems;
- Liver or kidney issues;
- High blood pressure;
- Infectious or contagious diseases;
- Mental illnesses, e.g. schizophrenia; - Any meds
- Use of MAO inhibitors;
- Use of Selective Serotonin Reuptake Inhibitors (SSRI’s);
- Epilepsy;
- Diabetes / low blood sugar / hypoglycaemia;
- Pregnancy;
- Any other health problems which may be relevant;
If yes to any of the above, please provide further details:
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*Please note that if you fail to disclose a health condition, we will not be prepared in terms of assistance.
Confirmation of physical condition and health:
Please list any special requirements or assistance you will need, any physical disabilities, allergies, past injuries, or other issues which should be noted.
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COVID:
By confirming to participate in a retreat, you acknowledge and take full responsibility of the risk. We as facilitators and retreat locations endeavour to follow Covid protocol guidelines to the best of our ability with respect and conscious responsibility. Should you feel symptomatic, please don’t come to the retreat.
Waiver and release of liability
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Signature
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PLEASE NOTE
Certain drugs and medications have been found to NOT be compatible with Ayahuasca. It is essential to stop taking the following substances, and give your system sufficient time to remove them from the body, before you begin a Retreat.
The following medications are unsafe in combination with Nixi Pae (Ayahuasca):
- Any medication that contains MAO inhibitors. It is critical that you stop taking these drugs and allow plenty of time for your system to be cleared of these substances.
- Any medication which has an effect on the serotonin system, including Selective Serotonin Reuptake Inhibitors (SSRI’s) - antidepressants such as Wellbutrin, Prozac, Zoloft, Effexor) We advise stopping with SSRI medications six weeks prior to a Retreat to allow the system to clear in time; some of these drugs may cause side effects when you stop taking them, and you should allow plenty of time for these to subside. You should not abruptly stop taking them without discussing the matter with your doctor. Please note that the herbal antidepressant St. John’s Wort (Hypericum Perforatum) also must not be taken directly prior to working with Ayahuasca, although the system can clear this in 2 weeks before commencing a Retreat.
- Other medications you must suspend taking are decongestants, cold medications, allergy medications, antihistamines, sedatives, tranquillizers, amphetamines (including Adderall), some hypertensive medications, sympathomimetic amines including pseudoephedrine and ephedrine, carbamazipine, methylphemidate (Ritalin), macromerine, phenelanine, tyrosine, tryptophan, asarone/calamus, asthma inhalers and diet pills.
- Medication and plant medicines are not designed to be used together, even vitamin pills can be contra-indicated as these often contain yeast and amino acids. Rather be safe and simply stop all pills before any ceremony.
- The following is strongly recommended from a dietary and lifestyle perspective: NO sugar, red meat, pork, alcohol, hot spices, animal products, cigarettes or inorganic beauty products. Little bit of good salt is fine. More information on preparation for the Retreats will follow closer to the events, and you will receive a list of these of these substances to avoid upon registration.
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