Registration form

Please select the date you want to reserve

2. 8 - 8 . 8. 2026 20. 9 - 26. 9. 2026 30. 1 - 5. 2. 2027

Personal Information

Gender

Men Women

Your name

Your last name

Age

Email confirmation

Your phone number

Residence

Emergency contact

What language do you speak?

Are you travel solo or in a group?

Solo In the group

If you are traveling with someone else and would like to share accommodation, please provide their name so that you can potentially share lodging together (However, each person should fill out the application separately)

Do you use drugs or have you used drugs in the past?

Yes No

If yes, please provide further information about types of drugs, the timeframe of dependency, frequency of use and your experiences with any therapy you've undergone.

Alergies

Preferred diet

Normal Vegetarian Vegetarian (Fish is ok) Vegan

Any other special dietary requirements?

Is this your first experience with ayahuasca?

Yes No

What are your reasons for participating in this ritual? What do you expect from it?

If you have anything else you would like to share, feel free 🙂

Read our policies:

“No Supplements, No Medications” This retreat involves the use of traditional herbal medicines, which may be contraindicated with certain medications, dietary supplements, or medical and psychological conditions. For this reason, we carefully assess the health status of each participant before participation, solely for their safety. The participant is required to truthfully and completely disclose to Amayas Ecuador S.A.S., prior to the start of the retreat, all herbal supplements, natural remedies, and medications (prescription and over-the-counter) that they have taken in the period of at least 30 days prior to the retreat, as well as any medications or supplements taken during the retreat. The use of any herbal supplements, natural remedies, or medications during the retreat is not permitted without the express written consent of Amayas Ecuador S.A.S. The participant confirms that all information provided in the application is true, current and complete, and that he/she has listed all relevant physical and mental health conditions, as well as all medications, supplements and natural products that he/she is taking or has taken.

Consent

Check this box if you agree.

By checking this box and entering my full name below, I confirm that: I have read and fully understand all of the above information, including the health and medical conditions of participation, I have truthfully and completely provided all relevant health, physical and psychological information, I am of legal age and voluntarily agree to the rules of the Amayas Ecuador S.A.S. retreat, I understand that providing false or incomplete information may result in my participation being denied or terminated, even without a refund, I agree that Amayas Ecuador S.A.S. is not responsible for any injuries, medical complications or other damages incurred during the retreat, I understand that Amayas Ecuador S.A.S. is not a medical facility and its owners, employees or representatives are not licensed physicians and do not provide Western medical

Consent

Check this box if you agree

Please write your full name in capital letters

7 day Ayahuasca retreat - 3 ceremonies

Please, fill out the registration form

Personal Information

Read our policies: