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| If you are coming with a friend or partner, please list their name here. |
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| Please provide details if you check any condition. Include diagnosis history, any past and current medications including dosage and time on meds. Enter "none" if none of the above have been checked. |
| Please provide details of any recent injury or active disability. |
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| Please provide details if you check any condition. Include diagnosis history, any past and current medications including dosage and time on meds. Enter "none" if none of the above have been checked. |
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| Please provide details if you check any condition. Include diagnosis history, any past and current medications including dosage and time on meds. Enter "none" if none of the above have been checked. |
| Enter "none" if you aren't currently taking any medications. |
| Enter "none" if you haven't taken any medications in the past. |
| Enter "none" if you aren't currently taking any vitamins or supplements. |
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| If you answered "yes" to the above question, please describe in detail your allergies. If this does not apply to you, write "none". |
| Enter "none" if you do not currently use any recreational drugs. |
| Enter "none" if you have not used any recreational drugs in the past. |
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| I understand that Blue Morpho ceremonies are purgative and dangerous while pregnant. If I become pregnant before the beginning of the retreat, I understand that I am responsible for notifying Blue Morpho and that I will not be able to participate during pregnancy. I also understand that I will only be entitled to a refund if the conditions of the Cancellation Policy are met. |
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| Please provide details if you check any condition. Enter "none" if none of the above have been checked. |
| We carefully screen each guest for their safety prior to attending a tour. All herbal supplements, natural medicines, and medications (prescription and over-the-counter) must be disclosed and subsequently approved for use by Blue Morpho. All herbal supplements, natural medicines, and medications (prescription and over-the-counter) cannot be taken during the course of the tour without the express permission of Hamilton Souther. You hereby agree that all information you provide in the application is correct and current and that you have disclosed all physical and psychological conditions as well as all herbal supplements, natural medicines and medications (prescription and over-the-counter) that you are taking. In some cases, you will be contacted personally by one of our staff to ensure that you are prepared for the experience. Blue Morpho is not a medical facility and its owners, staff, employees and agents are not licensed medical doctors, psychologists, or psychiatrists. We do not practice medicine, diagnose, cure, or treat disease or illnesses. Instead, we function as spiritual guides and teachers and offer ceremony for the purpose of spiritual communion. Dietary & Behavioral Restrictions: There are certain dietary and behavioral restrictions that must be followed. You will be advised of these restrictions when you arrive at the start of the tour. Some of our tours may have a different set of restrictions than contained in the following paragraphs. Each specific set of restrictions should be followed according to the corresponding tour. The amount of sweets that can be consumed on tour is limited. Consumption of alcohol and street drugs are not allowed at any time during the tour. Consumption of pork or pork products is not allowed during the entire tour and for 30 days after your last ceremony. You must also abstain from alcohol consumption and the use of street drugs for 7 days after. There is to be no sexual activity whatsoever between guests and/or staff during a tour. This includes married couples. This also includes masturbation. The environment demands abstinence from all sexual activity. Should you develop a sexual or romantic interest in another person, we request that you delay any physical displays or expressions of it until the tour is over. We are not attempting to create a moral or philosophical boundary but preventing the potentially dangerous crossing of energetic fields that can result from sexual or romantic behavior while engaged in ceremonies. Again, it is not important for the guest to understand this completely, but it is mandatory that the guest observe the rules. |
| By checking the box and typing my name in the field below, I attest that I have read and understand all of the above written medical information and have openly disclosed all requested health and medical facts. I attest that the information provided above is true and complete, to the best of my knowledge. I understand that falsifying or omitting any relevant information may be grounds for denying my attendance at the workshop for which I am applying, with or without a refund, at the sole discretion of Blue Morpho S.A, I hereby waive, release and hold harmless Blue Morpho S.A from any and all liability or responsibility for all injuries and/or damages or claims which may occur in the event I do attend the workshop.
I understand that by applying and paying for this retreat I am not entitled to a refund but only allowed to reschedule within a fiscal year. |
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| Please share what media or other source led you to Blue Morpho |
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| If so, enter your referral code here. |
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| Supplementary Products Exclusion: Participants acknowledge and agree that these Fees presented and payable pertain solely to Services and Offerings, and will not include the cost of any plant-medicines or similar products (collectively, "Supplementary Products") which may be provided, offered, or distributed by a Commercial User, or any other party, in connection with Services or Offerings. Retreat Guru shall bear no responsibility or liability in connection with any provision, offering, or distribution of Supplementary Products, and is not a party thereto. All capitalized terms used herein shall carry the same meaning as assigned to them in Retreat Guru's Terms of Service. |