Contamana Retreat Application

Please tell us if you have any disease, pathological or functional problem not considered here.
All the information provided will be kept private.
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IMPORTANT By clicking the SEND FORM button on the Application Form you agree to the following terms :
I understand that shamanic work may include the use of traditional healing plants.

I agree that I always have a choice whether or not to parti-cipate, and I agree to take full responsibility for the choices I make involving this work, both during and after the event.

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To the best of my knowledge, I am in good physical condition and I am not aware of any physical, physiological, or psychological infirmity which would place me at risk to participate in any way within the ceremony activities.

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I take full responsibility for my own belongings and safe transportation to and from the ceremony/workshop.

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I understand that the facilitators reserve the right to deny my participation if they deem that it would be unsafe for me, or for others, or for any other important reason.

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I agree to listen and follow the instructions given by the facili-tators.

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I take full responsibility for any damage that I may cause to the facility that is used for the ceremony.

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To maintain the safety, trust and respect for all participants, I agree to hold this work confidential. I will not reveal to anyone the identity of those who are participating in the event. This includes maintaining confiden-tiality for all facilitators, helpers, shamans or healers who are also participating in the ceremony.
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I hereby RELEASE, WAIVE, DISCHARGE AND COMMIT NOT TO SUE the event leader, organizers and/or participants for any and all liabilities, claims, demands arising from or related to the event.
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I agree to participate with the purest intention of heart, promo-ting the health and well-being of all participants.
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In signing this release (Clicking the Submit button), I acknow-ledge and represent that I have read and understand the above and sign voluntarily; I excuse this release for full, ade-quate and complete release of liability.

Contamana Jungle Journey 2026

So blessed that you will be joining me in this fantastic journey with the plant kingdom of the peruvian jungle. Let your soul guide you within where all the wisdom resides. Let the plant whispers open your heart and sacred vessel to the vastness of the Divine realm. The plant kingdom offers vibrational healing energies to uplift our sacred temple into more love. I look forward to journeying alongside of you. You are Divinely inspired.

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Today's Date

Contamana Jungle Journey Aug 1 - 19, 2026 - Required*

Please Choose Aug 1, 2026 as a ceremony date

Name - Required*

First Name Last Name

Address*

Street Address City State/Prov/ Postal Code

Best Phone # to reach you - Required*

Format (xxx) xxx-xxxx

Whatsapp (To reach you in the Jungle) - Required*

Format (xxx) xxx-xxxx

Best email address to reach you - Required*

Enter Email Confirm Email

Birth date - Required*

You must be of legal age to participate in these ceremonies or retreats. However, with signed parental consent, each applications is received with kind loving heart. Many young people are feeling called to their divine nature.

Occupation

Emergency Contact - Required*

You must provide the name of you emergency contact. It cannot be the same name or telephone number as yourself.

First Name Last Name

Emergency Contact Email - Required*

Enter Email Confirm Email

Emergency Contact Phone # - Required*

Format: (xxx) xxx-xxxx

Doctor's Name

First Name Last Name

Doctor's Contact Phone #

Please enter 555-555-5555 if you do not have a physician

Do you have any dietary restrictions or special needs for your body - Required*

Please answer the following questions

These sessions are for the personal growth of participants and should not be considered as a substitute for psychotherapy, medical or psychiatric care. The work can involve intense experiences accompanied by strong emotional and physical releases. Participation is not recommended for people with: severe, decompensated or disabling health problems: cardiovascular (uncontrolled hypertension, history of myocardial infarction or heart failure), glaucoma, recent fractures, recent surgeries, pregnancy, lactation, acute infectious diseases, epilepsy or seizures, stroke, certain psychiatric pathologies (such as psychotic episodes, borderline personality, bipolar syndrome), severe liver, kidney or pancreas diseases, severe respiratory failure. Contraindicated medications: Hepatotoxic medications, emetics. Drugs or substances that alter the state of consciousness. Monoamine oxidase inhibiting drugs (MAOIS) as in the case of many antidepressants and other drugs. It is risky to combine this work with substances with an effect on the serotonergic system such as MDMA and the like. The combination with Yopo, Vilca or Bufo Alvarious is also risky. The combination with other medications such as antipsychotics or mood stabilizers should be evaluated by a professional. The list of contraindicated substances includes without being limited to: Demerol, some nasal sprays, weight loss drugs, amphetamines, ecstasy, cocaine, heroin and their derivatives. If you are currently taking any medication or substance contraindicated with Ayahuasca you should discuss with your doctor if it would be safe to stop taking the medication several weeks before, during and after an Ayahuasca intake. You should not stop taking medication prescribed to you without your doctor’s approval consulting. We are not responsible for any decision on your part to suspend the medication. If you have any questions as to whether you should participate in the session, it is essential that you consult your doctor or therapist, as well as the maestros. The following questionnaire aims to guide the organizers and avoid risks to the health of the participant and the safety of the other participants. This information will be stored securely and kept confidential. Please respond with absolute honesty and fill in all fields. We decline all responsibility for any problem arising from the omission or lack of veracity in the answers to the following questions. We also ask to let us know if you have any disease, pathological problem or functional (physical or psychological) not considered in this questionnaire. This form is part of your registration and we will not be able to confirm your participation until we have received it fully completed.

Do you have experience with psychedelic/entheogenic plant spirit medicine? (like Ayahuasca, San Pedro, Mushroom) - Required*

(If yes, detail date, maestros, place, and how was you experience)

Please describe your medical history, past and present conditions. - Required*

Explain any body aches and pains, PTSD, anxiety, childhood trauma, any suspected abuse or anything that is causing you to feel less then.

How long have you dealth with this condition? - Required*

Current state: (symptoms,no symptoms, stabilized,under treatment) - Required*

Do you take medications for this condition? Detail medication - Required

Are you taking any of the following groups of medications? - Required*

Many medications prescribed by your doctor maybe incompatible with these ceremonies.

Are you currently pregnant or breastfeeding? - Required

Do you have a past history, have you been diagnosed with, or are you currently sufferingfrom any of the following conditions?:*

Please select all that applies

If you have checked any of the boxes above, please give details about the condition (time with condition, if you take any medication, etc)

Have you had a surgical procedure recently, difficulty moving, fractures, or dislocations? (Explain details, for how long with condition, if you take medication)

Do you have any mental health conditions? If yes, specify how long.

Please check the boxes if you have ever been diagnosed with the following*

Please select all that applies

Have you ever been hospitalized for psychiatric reasons? Please detail

Are you currently receiving treatment for any of these condition?

Do you still have symptoms?

Are you currently in therapy or involved in some type of support group?

Are there people in your family with a history of psychiatric disorders?

Have you been hospitalized for medical reasons in the past 20 years?

Do you have any drug-specific allergies?

Please specify if you suffer or have suffered from any infectious of contagious disease

Are you currently taking any type of medication prescribed or not? In the last 12 months? If yes, list all medications including dose, frequency and duration of use.

List any supplements (herbs or vitamins) that you have taken in the last two months. Please include the dose, frequency and duration of use.

Have you taken any recreational/psychoactive drugs in your lifetime? (including alcohol and marihuana. Specify dose, frequency, and duration of use)

Do you have hypersensitivity to tobacco?

Do you have hypersensitivity to psychoactive agents?

Have you experienced adverse effects or very difficult experiences with a psychoactive substance?

Have you ever experienced spiritual phenomena? Specify

How many years of experience do you have with spiritual and/or personal development? - Required*

What is your intention for your healing process with Grandmother Medicine? - Required*

“It is important to formulate an intention when journeying with Plant Spirit Medicine as a point of focus for your preparation for the journey. But it's also important to distinguish between intention and expectations, because the way to your intention is, most likely, not through achieving your expectations, because your expectations are largely part of your consciousness and so much of what Ayahuasca is, relates to your subconscious and that which is even greater or outside of us, which your consciousness knows nothing about. In fact, you can achieve your intention, even though it does not feel as if you have, because what you experienced was part of some necessary preparatory healing or because you received a precise but indirect answer”. A good intention is like having a map for reaching the wisdom that will help you in your healing journey. Please be specific with a realistic Intention. You do not get into your car and drive without a destination in mind. Intention is the direction of your journey.

Please tell us about your occupation and the environment you will be returning to after your stay with us. This is important information so that we are able to recommend appropirate integration support.*

Do you have a heart condition, or have you ever had an ECG test to screen for this? - Required*

Do you have allergies or dietary requirements? - Required*

What spiritual practices if any, do you engage in? - Required*

What daily practice do you do that anchors you soul into form?

I agree to follow and commit to the Pre & Post diet guidelines found on this website and I certify that I have answered truthfully all questions. - Required*

Dietary guidelines found hereL https://maestralaynah.com/peruvian-medicine/preparation-and-after-care/diet-guidelines/ Medical guidelines found here: https://maestralaynah.com/peruvian-medicine/preparation-and-after-care/medical-guidelines/

YES

I hereby confirm that I have read and understood the above information and have answered all the questions completely and honestly and have not withheld any information. My general health, as far as I am aware, is good.*

YES

I the undersigned hereby seek to participate in a traditional Shipibo Amazonian medicine ceremony. I agree to complete the Confidential Medical history form provided. I am assured that the information provided will remain strictly confidential and will serve only as a guide in determining the appropriateness of my participation in the ceremony and in meeting my needs before, during and after the ceremony.*

YES

Any other information you would like to convey that we may hot have asked?

Application Supplemental Notes - Required*

If you did not receive a confirmation email that your form has been sent, it is more and likely that you missed one item in the form. This process is not immediate and can take up to a week or more. Please DO NOT make travel arrangements until you have been approved. *** THERE ARE NO REFUNDS ***

I have read the Medical Guidelines for any contra indicated medications

I understand that once I commit to a ceremony, there is NO REFUNDS

Check your spam/junk folder for emails from ceremonies@maestralaynah.com or maestralaynah@gmail.com

Digital Signature (Name and Last Name)

Answer this section about dieta

Dieta is a sacred and special process that implies forming a life-long relationship with a plant spirit. If the dieter successfully concludes the dieta and follows post-dieta instructions they can receive the benefits for their body, mind, and spirit. Dieta requires participants to adhere to special food (as served in our center) and behavioral protocols (no sexual or highly disturbing behavior).

Have you dieted a master plant before? If so what plant was it, how long, and under what maestro/a?

What was your experience with that/those diet(s)?

Please state your intentions with the diet you plan on undertaking with us.

YES

Digital Signature (Name and Last Name)

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