Returning Guest Form Please take a moment to consider any changes in your life since we’ve seen you last Name * First Name Last Name Email * Briefly share with us how you are doing overall, to include any consequential, significant, or meaningful life events since last filling out the Wise Warrior application (i.e. successes, shifts, difficulties or stressors; death of a loved one, move, change in job or relationship status, or anything else you think relevant for us to be aware of, etc.): * Please share any changes to your physical/medical health? (Diagnoses, surgeries, changes in physical condition, status of a chronic health issue, etc.): * Please share any changes to your mental & emotional health? (Diagnoses, persistent conditions, considerable mood disruption, resolved issues, etc.): * Please share any changes in medication - either additional prescribed medications/supplements, or medications/supplements that you no longer take: * If you’ve participated in other ceremonies since being with Wise Warrior, please share which medicine you sat with, and if you had any unusual episodes (i.e. psychosis, loss of memory, removal from the circle by facilitators, etc.). Please know that this does not disqualify you from our retreat, but rather allows the staff to work closely with participants to provide the greatest level of safety and support: * Are there things you’d like to share during the retreat? (i.e. a song, reading/poem, story, musical instrument, creative endeavor, group experiential, etc.) No pressure but let us know if you have something in mind and we’ll check in with you about it! * Policy Regarding Ketamine * Wise Warrior has a new policy that applies to recreational, ceremonial, and/or clinical use of Ketamine. We request that participants refrain from Ketamine for 6 months prior to ceremony. This policy is designed to prioritize emotional, mental, and spiritual safety above all else. Please know that we’re happy to talk through any questions or concerns you have if necessary - just let us know and we’ll find a time to connect. Confirm 'yes' that you will NOT utilize Ketamine 6 months prior to our retreat on March 7-14, 2026. Yes No Plant Medicine Ceremonies + Consent * Please note that certain drugs and medications have been found not to be compatible with the Amazonian plant medicine optionally offered at this retreat. It is important that you know the following information so that you can be educated regarding contraindications in your decision as to whether or not to participate in these ceremonies. It is NOT safe to work with this plant medicine if you take any of the following drugs or medications. -Any medication that contains Monoamine Oxidase Inhibitors (MAOI's) -SSRI's (any Selective Serotonin Reuptake Inhibitor) -SNRI's (Serotonin-Norepinephrine Reuptake Inhibitors) -Antihypertensives (high blood pressure medication) -Appetite suppressants (diet pills) -Medicine for asthma, bronchitis, or other breathing problems; antihistamines, medicines for colds, sinus problems, hay fever, or allergies -CNS (Central Nervous System) depressants -Antipsychotics -Barbituates -Any Illicit Drugs We do suggest a minimum one week abstinence from alcohol and/or marijuana in preparation for ceremonies as well. It is essential to stop taking the above substances, and give your system sufficient time to remove them from the body (a minimum of 3 months), before you begin our retreat: Please consult your doctor for guidance on a plan to taper. You should certainly NOT suddenly stop taking prescribed medications (including antidepressants) without consulting your doctor. It is also not safe to work with this plant medicine if you have any of the following health conditions. -You are pregnant -You have a heart condition or chronic high blood pressure -You have a history of severe psychological problems, including bipolar mood disorder, mania, psychosis, schizophrenia, or depersonalization Also, if you have a close / strong family history of severe mental illness, such as bipolar mood disorder, schizophrenia, or depersonalization, it is possible (although highly unlikely) that this plant medicine can unmask such symptoms in predisposed individuals. People with this family history or personal history are advised not to partake in plant medicine ceremonies. Please refer to the criteria below to make sure you: 1) have no direct history of major issues of bipolar, psychosis, or depersonalization 2) that you have not previously taken any medication for these conditions 3) are not currently taking any psychiatric medications Provided none of these three points are applicable, the facilitator may be able to accommodate you in the plant medicine ceremonies. However, please inform us if you have any history of severe mental illness in your family, and of any medications you are currently taking, as it is crucial for your safety and your appropriateness will be assessed on an individual basis. AGREEMENTS: I understand that this retreat includes the optional use of traditional healing plants (also known as ‘plant medicine’). I hereby agree that I always have a choice whether or not to participate in any activity using such plants, and I agree to take full responsibility for the choices I make involving this work during and after the event. I further agree to fully disclose my health history, including my mental health, medications, and substance use, prior to participating in any plant medicine ceremony. I understand that approval for my participation in this work at the time of the event is entirely at the discretion of the facilitator and is not automatic. The facilitator reserves the right to deny my participation if she deems that it would be unsafe for me or others, or for any other important reason. To maintain the safety and trust of all participants, I hereby agree to hold this work confidential. I will reveal to no one the identity of persons participating in the plant medicine ceremonies or anything they reveal about themselves or others. This includes maintaining confidentiality for any facilitators, helpers, or healers participating in the ceremony. I agree to participate with the intention of promoting the health and well-being of all participants. Understanding all of the above, I will be participating in the sacred plant medicine ceremonies. Yes No The information I have entered above is true. Electronic Signature: * First Name Last Name Today's Date * MM DD YYYY Thank you, your updated information has been submitted!
