Blue Morpho Lodge Small Group 2 San Pedro and 2 Ayahuasca Ceremonies.

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Retreat Guru is the online booking agent for Blue Morpho Tours.

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1 Welcome

2 Price

3 People in your group

Guest 1		First Name* Last Name* Email* Gender*
Guest 1		First Name* Last Name* Email* Gender*

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4 Participant Info

NOTE	Please note that Sanango dietas are for RETURN GUESTS ONLY. We require you to have completed at least one ayahuasca workshop with Blue Morpho before being eligible for a Sanango dieta. Please only complete this application if you meet this criteria.
IMPORTANT NOTE	If you have any health conditions or take any medications please email us at admin@bluemorphotours.com to discuss your suitability for participating in ayahuasca ceremonies before you make a booking and submit payment. Medications can not be taken during the retreat time and most have to be stopped with doctor's permission one month before the retreat. Some health conditions make it very unsafe to participate in ayahuasca ceremonies.
Confirm *	Please check the box to indicate that you have read and understood the above information.
Email newsletter	Please send me the email newsletter
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Country that issued Passport *
Birth Date *
Weight
Gender *
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Profession *

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5 Emergency Contact Information

Emergency Contact *
Relationship *
Emergency Phone Number *
Emergency Email *

6 Meals and Accommodations

Diet Preference
Diet Notes *	Please list any food allergies, intolerances or special requests that you have. If you have none, write "none."
Room Share Type *	If you are coming with a friend or partner, please indicate if you would prefer a twin or matrimonial room.
Room Share Option *
Requested Roommate	If you are coming with a friend or partner, please list their name here.
Desired Roommate *	If you are coming with a friend or partner please list their name here.

7 What would you like to focus on?

Spirituality *	Spiritual Growth Ascendance Enlightenment Universal Truth Divinity Seeking Power Animals Meeting Spirits Soul Retrieval Cleansing Straighten Energy Chakra Cleansing Past Life Regression
Mental Health *	General Mental Health Mental Abuse Emotional Pain Past Trauma Release Negativity
Physical Health *	General Physical Health Physical Pain Physical Abuse Sexual Abuse Addiction
Health and Well-Being *	Life Purpose Career Change Creativity Personal Growth Learning Curiosity Heart Center

8 Medical History Information

Physical Health	Diabetes Epilepsy or Seizures Obesity Visual Impairment Infectious Disease Physical Disability Thyroid Conditions None
Physical Health Details & Medications *	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.
Recent Injuries or Active Disabilities	Please provide details of any recent injury or active disability.
Heart Health	High Blood Pressure Circulatory Problems Stroke Heart Attack Irregular Heartbeat Aneurism None
Heart Health Details & Medications *	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.
Mental Health	Mental Disorder Anxiety Disorder Clinical Depression Dissociative Identity Disorder (MPD) Bipolar Schizophrenia Suicidal Ideation Self Harming OCD ADHD PTSD Autism Alcoholism or Drug Addiction None
Mental Health Details & Medications *	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 list any other medications you are currently taking including the dosage and time on medications. *	Enter "none" if you aren't currently taking any medications.
Please list any other medications you have taken in the past. Include when you took them and how long you were on them. *	Enter "none" if you haven't taken any medications in the past.
Please list any vitamins or supplements you are currently taking. *	Enter "none" if you aren't currently taking any vitamins or supplements.
Allergies to Medications
Do you have any severe or potentially life-threatening allergies that would require the use of an epi pen? *	Yes No If you answered "yes" to this question, please be sure to bring an epi pen with you, as they are very difficult to obtain in Iquitos, Peru.
Please describe your allergies.	If you answered "yes" to the above question, please describe in detail your allergies. If this does not apply to you, write "none".
Please list any recreational drugs you currently use. *	Enter "none" if you do not currently use any recreational drugs.
Please list any recreational drugs you have used in the past. *	Enter "none" if you have not used any recreational drugs in the past.
Are you currently pregnant? *	Yes No
Pregnancy Disclaimer *	By clicking here, I agree with the following:I understand that sacred plants are purgatives and dangerous to consume 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 ingest any sacred plant during pregnancy. I also understand that I will only be entitled to a refund if the conditions of the Cancellation Policy are met.
Family Medical History	High Blood Pressure Circulatory Problems Stroke Heart Attack Heart Surgery Irregular Heartbeat Aneurism Diabetes Epilepsy or Seizures Obesity Visual Impairment Infectious Disease Physical Disability Thyroid Conditions Mental Disorder Anxiety Disorder Clinical Depression Dissociative Identity Disorder (MPD) Bipolar Schizophrenia Suicidal Ideation Self Harming OCD ADHD Autism
Family Medical History Details *	Please provide details if you check any condition. Enter "none" if none of the above have been checked.
BMT Health Screening & Full Disclosure *	Check this box if you agree to the BMT Health Screening and Full Disclosure.Because some of our tours involve the ingestion/utilization of sacred plants, 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 BMT. 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 Gustavo Padron. 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. BMT 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: Because some of our tours involve the ingestion of sacred plants, 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 due to the use of sacred plants 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 shamanic ceremony with sacred plants. You must also abstain from alcohol consumption and the use of street drugs for 7 days after your last ingestion of sacred plants. 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 shamanic ceremonies. Again, it is not important for the guest to understand this completely, but it is mandatory that the guest observe the rules.

Please read and agree to the terms indicated here: *	I accept the terms and conditions.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.
Guest Contract *	I confirm that I have read and agree to the Guest Contract and acknowledge that I will need to sign a paper copy of the contract when in PeruPlease read the Guest Contract here
Please type your name in CAPITAL letters *

1 Welcome

2 Price

Select an option*

Blue Morpho Lodge (private room)

3 People in your group

4 Participant Info

5 Emergency Contact Information

6 Meals and Accommodations

7 What would you like to focus on?

Spirituality

Mental Health

Physical Health

Health and Well-Being

8 Medical History Information

Physical Health

Heart Health

Mental Health

Family Medical History

BMT Health Screening & Full Disclosure

9 Travel Insurance

10 Referral (first time guests only)

11 Terms and Conditions

12 Payment