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Uplift Heal Awaken

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Registration Details

Please thoroughly read and fully answer the following questions.
First Name*
Last Name*
Country*
Address*
Email Address*
Do you want to receive updates on upcoming SPJ programs, online courses, and blog posts?*
We will absolutely not spam you. We promise.
Phone Number*
Can SPJ reach you via WhatsApp?*
We use WhatsApp to communicate with you before, during, and after retreat.
Gender & Pronouns (Non-Binary)*
Birth Date*
Special Dietary Restrictions / Preferences*
Dietary Allergies, Preferences & Restrictions
Do you have any severe or life-threatening allergies?*
If so, please provide an in-depth description
Emergency Contact Info*
Please take the time to read and answer this next section thoughtfully, carefully and thoroughly.

Your safety is our
highest priority.

Working with traditional plant medicine is not inherently dangerous, but there are many medications and health conditions that are incompatible with plant medicine, and can put your health and life at risk on retreat.

To be able to safely accommodate you, we need you to be fully transparent with us about your medical history, current and past drug use (prescription & otherwise), and any other information that you can even imagine might be relevant. 

It is your responsibility to be fully informed of the potential risks of working with traditional plant medicine, and to fully and completely inform us regarding your medical, psychiatric, and substance use history.
We understand that you might be sharing sensitive and deeply personal information in the following section. 

The information you provide in your registration details and medical questionnaire is completely and entirely confidential, and will never be accessed or viewed by anyone outside of our team.

The Ayahuasca Diet

In preparing for retreat, we ask all guests to follow a more or less traditional Ayahuasca diet. Observing the diet is an important part of preparing your body and energetic field for ceremony.

After booking your retreat, we will send you a PDF with the diet guidelines that we’ve determined from experience. However, it is important that you are familiar with what the ayahuasca diet entails before committing to coming on retreat.

You can find an exhaustive (but by no means complete) list of foods, drugs, and medications incompatible with ayahuasca at the
following link:

Medical Questionnaire

Please take the time to read and answer the following
questions thoughtfully, carefully, and fully.

First Name*
Last Name*
We're asking for your name again for our record-keeping.
Have You Ever Participated in an Ayahuasca Ceremony?*
If so, please describe your previous experience (date, location, experience, etc.)
Have You Previously Experienced Psychoactive or Hallucinogenic Substances?*
Psilocybin Mushrooms, LSD, DMT, etc.
If so, please describe substances used, & your experience.
Are You Currently Pregnant?*
If so, please share your approx. pregnancy timeline.
Check any physical health conditions that you are currently experiencing or have experienced in the past. Check all that apply.*
If you checked one of these boxes, please provide us with an in-depth description.
Are you currently taking or have you ever been prescribed any medications for these condition(s), or for any other condition not mentioned above?*
If you chose yes, please provide a full, in-depth description of previous and/or current medication.
How would you describe your current state of health?*
Have you ever undergone surgery requiring a general anaesthetic?*
If you chose yes, please provide an in-depth description of past surgery.
Please check any psychological / psychiatric conditions from the list below that you have either experienced in the past or are currently experiencing. Please check all that apply.*
If you checked any of the above boxes, please provide us with an in-depth description.
Are you currently taking or have you ever been prescribed any medications for these condition(s), or for any other conditions not listed above?*
If you chose yes, please provide a thorough and complete description.
Do you have a family history of any of the above conditions?*
Please specify which family member(s), which condition(s) and the current state of health of those family members.
Have you ever been diagnosed, treated, or self-identified with alcohol or substance abuse disorder?*
If you chose yes, please provide us with some additional information about your experience, including the date(s) or time span of your addiction and whether you have undergone any therapy or rehabilitation to heal.
Have you ever experienced addiction to any other substances or activities (eg., work, sex, food, gambling) currently or in the past?*
If you chose yes, please tell us more about your experience.
Are you allergic to any medication?*
If you chose yes, please specify which medications.
Are you currently taking or have you recently stopped taking anti-depressant medication?*
If you chose yes, please specify which medication(s), length of time, when you stopped, etc.
Are you currently taking or have you recently stopped taking any other prescription medications?*
If you chose yes, please provide us with an in-depth description.
Are you currently taking or have you recently stopped taking any natural supplements, herbal medicines, or vitamins?*
Please specify which supplement(s), and provide a description of supplement regimen.
Do you have any severe or life-threatening allergies that would require use of an Epi-Pen?*
If you answered yes, please provide us with an in-depth description.
Is there anything concerning your physical and psychological health history that has not been covered by this questionnaire that you would like to share with us? *
If you chose yes, please provide us with an in-depth description.
Have you experienced what you would regard as a traumatic incident in your past that you would like us to know about?*
We're here to hear you.
We cannot mention or ask about all possible physical or psychological health conditions. Bearing in mind that it is your responsibility to make sure that we are aware of any factor that might put your safety at risk on retreat, if there is anything else that you feel we should be made aware of, please provide an in-depth description below.
I have disclosed all past and current prescription medications, medical treatments, and/or therapy that I am currently taking or have taken/undergone.*
I have completed this questionnaire myself, have answered truthfully, and understand that withholding or misrepresenting any information could result in serious complications when drinking Ayahuasca. I understand that I am ultimately responsible for being aware and informed of potential health & safety risks when participating in an Ayahuasca ceremony.*
I will discontinue all use of alcohol, marijuana, recreational, street drugs and non-prescribed pharmaceuticals at least 3 weeks prior to commencing my retreat. I understand that many street and recreational drugs are strongly contraindicated with Ayahuasca and can be very dangerous and potentially fatal when combined.*

The following section includes our
Ceremony & Retreat Terms & Conditions. 

Please take the time to carefully read these
before booking your retreat.

Terms & Conditions

Please thoroughly and carefully read the following Terms & Conditions. 

If you have any questions, please feel free to reach out to us directly
via Facebook Messenger
(by clicking the button to the right),
and we’ll get back to you as soon as we can.

First Name*
Last Name*
We're asking for your name again for our record keeping.
I have read, fully understood, and agree to the terms and conditions outlined in the Retreat Terms & Conditions*
I have read, understood, and fully agree to the terms & conditions outlined in the above Retreat Cancellation Policy*
I have read, fully understood, and agree to the terms and conditions outlined in the above Ceremony Terms & Conditions.*

Okay, the hard part’s over.
Let’s book your retreat!

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Smith Family Private Retreat

Included:

5 Traditional Shipibo Ayahuasca Ceremonies with SPJ Maestra

1 Intensive Temezcal Sweat Lodge Ceremony

All transportation from when you arrive the airport in Cusco to when you leave (not incl. additional trips during or outside of retreat)

1:1 Facilitation

Delicious Aya-diet friendly food, cooked by our chef.

Ceremonial, medicinal flower baths after each ceremony

Local Andes Hikes to waterfall and river

Group Sharing Circles after each ceremony

Group Sharing & Intro Circle with our Maestra

Yoga Sessions on ceremony days

Pre-Ceremony Guided Meditation

Optional Sound Healing Session

Individual Massage Sessions

On-site medical screening with our doctor on day one (our doctor will also be on call during the entirety of the retreat.)

1:1 pre-retreat check-in, medical screening, & intention-setting call w/ SPJ Integration Specialists

Andean “Despacho” Offering Ceremony (“Ayni” offering in Q’ero mystic tradition) in order to close the retreat and set homeward intentions. (Our Q’ero Maestra also provides Optional Coca Leaf Readings)

Not Included:

Machu Picchu Excursion (Arranged at-cost, with $45 USD admin fee per guest)

Pisac Ruins Excursion (Arranged at-cost)

Additional Excursions (Arranged at-cost)

Clear
©2020/2021 Uplift Heal Awaken LLC  | All Rights Reserved. | We Love You.

©2020/2021 Uplift Heal Awaken LLC  | All Rights Reserved. | We Love You.

Retreat Terms & Conditions

Your retreat package reflects an international partnership between Uplift Heal Awaken LLC, a US-based tourism agency (providing travel logistics, support, accommodation booking, transportation, etc.) and Spirit Plant Journeys, an independent entity providing traditional plant medicine ceremonies in Sacred Valley, Peru.

Your payment for this package directly reflects a transaction between you and Uplift Heal Awaken LLC for the aforementioned services, and is not in any way, shape or form in exchange for the use, sacramental or otherwise, of substances classified under Schedule I of the US Controlled Substances Act of 1970.

The ceremonial use of Ayahuasca is legally permitted under Peruvian law, and is considered a part of Peruvian national heritage. Any plant medicine ceremonies, rituals, or sacramental rites undergone or experienced during this travel & retreat package are subject to the laws, customs and regulations of the country in which they are experienced. Any plant medicine ceremonies referenced in this retreat package, or undergone/experienced during your retreat are provided separately by Spirit Plant Journeys, payment for which is available by voluntary donation on-site.

All information included in this registration form & questionnaire has been collected by Uplift Heal Awaken LLC in order to fully inform the Spirit Plant Journeys team regarding guests prior to retreat. The information you have provided is completely confidential, and will never be shared with anyone outside of the Uplift Heal Awaken and Spirit Plant Journeys teams.

While we take every precaution to make sure you will be safe while on retreat, Uplift Heal Awaken LLC is not responsible in any way, shape, or form to exposure to or contraction of COVID-19 before, during, or after your retreat.

Ceremony Terms & Conditions

The following terms and conditions have been designed as a result of our experience, and serve to prepare our guests for a positive and safe experience in ceremony. The ayahuasca used by Spirit Plant Journeys is an Amazonian decoction of the vine banisteriopsis caapi (ayahuasca) and the leaves of the shrub psychotria viridis (chacruna). We do not use any other plants in our ayahuasca.

The healers and facilitators administering the ayahuasca will use their discretion to adjust the dose for each participant. The effects of ayahuasca may include temporary changes in your perception of reality and way of thinking, visions (of abstract motifs or clearly identifiable images and scenarios), heightened negative and positive emotions, access to detailed memories that you had forgotten, paranormal phenomena, the emergence of fears or difficult emotions (some of which may be associated with blockages in the body causing pain and tension), introspection, and perinatal or transpersonal experiences (in which you may experience your own death and rebirth). On a physical level, you may experience nausea, vomiting, chills, tingling, ringing in the ears, dizziness, diarrhea, tremors, sweating, ataxia, and, in rare cases, fainting. Sometimes, especially if you have not drunk ayahuasca before, you may not notice any visionary effects. If that happens, it does not mean the ayahuasca is not having an effect on other levels.

The ayahuasca experience is not linear, but rather it passes through different phases, some more pleasant, even euphoric, and others more difficult. Ayahuasca works to integrate unresolved aspects from the past that have arisen typically from trauma, emotional loss, neglect, abuse, and general emotional and psychological difficulties. During and after ceremonies it is not uncommon to experience emotional, psychological, and physical discomforts, which are typically symptoms of the healing process as ayahuasca helps you to integrate issues from the past that have been trapped in your system.

The healers and facilitators are committed to protecting your physical and emotional security, integrity, and privacy throughout the process, and intend to provide you with the psychological and physical support you need during the preparation phase, the ceremonies themselves, and the period afterwards. We have an emergency protocol and commit to provide any necessary support should the need arise.

Your participation in the ceremonies is entirely voluntary and you are free to opt out, if you wish, before the start of the ceremony. However, you must follow the instructions of the facilitators and healers at all times so that your safety is not jeopardized. The healers and facilitators may, at any time, decide to exclude you from participation in a ceremony for any perceived impairment in your physical or psychological health that risks leading to problems for you during the ceremony, or if you do not meet the requirements for participation for any other reason.

Working with ayahuasca is not a substitute for medical, psychiatric, or psychotherapeutic treatment, but may complement a therapeutic process and facilitate personal development. If you are currently receiving treatment of any kind or taking any medication, you must provide the full details of your situation prior to booking a workshop. If you agree to participate in a ceremony with Spirit Plant Journeys, you are required to honestly and fully complete a medical questionnaire. You must answer all questions honestly and to disclose any relevant personal information about your health.

By accepting these Terms and Conditions, you also agree to the following Declaration, wherein “I” refers to “You”, the participant in ceremony. You will be required to sign a copy of the following Declaration and Terms and Conditions onsite before entering ceremony with Spirit Plant Journeys.

Declaration

I am aware that participation in ceremonies with Spirit Plant Journeys involves the use of ayahuasca and various Amazonian medicinal plants, which are traditionally used in the Amazon rainforest for shamanic healing.

I understand that taking these plants may involve emotional, psychological, and physical reactions, and I agree to take part and abide by the Terms and Conditions in this document and any other instructions given orally or in writing.

I declare that I am choosing to participate of my own free will and have not been coerced into participating in a workshop by the organizers or by any other person. The decision to participate is mine alone, and is based on my own personal assessment of the effects, the exclusion criteria, the potential risks and benefits, the focus of the ceremonies, and the Spirit Plant Journeys team.

Spirit Plant Journeys has explained to me what to expect from ceremony and how it is intended to proceed. I am aware that I can ask questions about the ceremonies at any time and can change my mind about attending at any time before the ceremonies begin.

I have answered all questions honestly and transparently during the screening process, and understand that I must respond to all follow up questions in order to participate in ceremony. I agree to provide all relevant information regarding my medical history, mental and physical health, and any other information that may serve to protect my health during this process.

I have made the confidential disclosures requested by the Organizer and these are honest and accurate regarding my needs and condition(s). I understand that these will be kept in the strictest confidence. I reiterate my understanding of this by signing this form.

I accept full responsibility for participating in ceremonies with Spirit Plant Journeys.

I understand and agree that I can be excluded from participation in a workshop or ceremony at the discretion of the facilitator.

Terms & Conditions

This agreement is between Spirit Plant Journeys (the Organizer) and You (the Participant). By participating in a ceremony with Spirit Plant Journeys, you agree to all of the following items listed:

1. The Participant agrees to take part in ayahuasca and medicinal plant ceremonies with the Organizer, has been advised that ayahuasca is a visionary plant, and is clear on the meaning of this.

2. The Organizer will do their utmost to ensure the safety and comfort of the Participant within the remit of the workshop. The Participant, in turn, agrees to exercise caution and consideration for themselves and for others during this event, and indemnifies the Organizer against claims for injury or loss.

3. The Participant agrees to respect all individuals at all times. Overt negativity or disruptive negativity detracts from the experience of the others.

4. The Organizer reserves the right to expel any individual who is acting in an excessively negative manner or disrupting the group, staff, and/or shamans, without prior notice, responsibility for a refund, or providing accommodation outside of the retreat.

5. If a Participant’s behavior presents a threat to the safety of themselves or others, the Organizer reserves the right to physically restrain the Participant and/or expel them from the workshop without prior notice, responsibility for a refund, or providing accommodation outside of the retreat grounds. Restraint will be conducted as gently as possible and with respect for the dignity of the Participant.

6. Sexual activity between Participants and/or staff is prohibited. This includes married couples. Should a Participant develop a sexual or romantic interest in another person, any sexual contact/activity must be delayed for two weeks after the last ceremony. As a reminder, we are not attempting to create a moral or philosophical boundary but preventing the potentially dangerous crossing of energetic fields, which can result from sexual behavior while engaged in ayahuasca ceremonies. The Participant agrees to maintain sexual abstinence for two weeks before the first and two weeks after the last ceremony.

7. The Participant, prior to entry into this Agreement, agrees to obtain health or medical advice as to the effect of plants singly and in combination with any medication they are taking.

8. The Participant agrees that they are in a physical and mental condition appropriate to the activities described in this workshop and agrees to participate at their own risk. The responsibility for taking accurate and timely health precautions and professional medical advice is with the Participant.

9. The Participant agrees to full disclosure with Organizer, in writing, regarding their health history, medical conditions, and any medications they are taking, prior to booking.

10. The Participant agrees to notify the Organizer of any change in their medical circumstances and understands that withholding medical information could be dangerous to their health.

11. The Organizer is not responsible for the personal decision of any guest to stop taking medication or change their medication schedule, and accepts no liability for any adverse effects from withdrawal from any medication.

12. The Participant confirms that they have not been diagnosed with any psychotic disorder, including schizophrenia, schizophreniform, schizoaffective, delusional, or bi-polar disorder.

13. The Participant understands and agrees to adhere strictly to the required diet, drug, and pharmacological restrictions required by Spirit Plant Journeys for at least two weeks prior to the first ceremony and for at least two weeks following the last ceremony. The three most fundamental restrictions are street drugs (cocaine, ecstasy, LSD, etc.), sexual activity, and pork.

14. If the Participant does not adhere to these Terms and Conditions as well as all restrictions required by Spirit Plant Journeys, the Organizer will not be held liable for the consequences (which can be severe psychological and energetic damage), and reserves the right to expel the Participant without prior notice, responsibility for a refund, or providing accommodation outside of the retreat grounds.

15. If the Participant is found to possess prescription drugs that have not been approved by the Organizer prior to their arrival, street drugs, or alcohol, the Organizer reserves the right to deny them entry to the retreat grounds and/or ceremony or expel them from the retreat without prior notice, responsibility for a refund, or providing accommodation outside of the retreat grounds.

16. The Organizer may require the Participant to take a drug or breathalyzer test prior to or during a workshop, without prior notice or reason. If the Participant refuses to comply with the test, the Organizer reserves the right to deny them entry to the ceremony and/or the workshop and/or expel them from the workshop immediately and without prior notice, responsibility for a refund, or providing accommodation outside of the retreat grounds.

17. The Organizer is not liable for the injury of any Participant that may occur during or after the workshop. By participating in ceremony with Spirit Plant Journeys and accepting this Agreement, the Participant expresses full understanding of and responsibility for the risks that they may encounter during a workshop. The Participant absolves Spirit Plant Journeys, its owners, affiliates (namely, Uplift Heal Awaken LLC) and employees of said responsibility. Any legal action taken against Spirit Plant Journeys will only take place in Peru under Peruvian Law.

18. In the case of a medical emergency during a workshop, the Participant will be accompanied by a Spirit Plant Journeys representative to a nearby medical facility for treatment.

19. The Organizer reserves the right to expel any guest without prior notice, responsibility for a refund, or providing accommodation outside of the retreat grounds.

20. Should a Participant decide to leave a workshop prematurely, for any reason, the Organizer is not responsible for the reimbursement of monies or for denouncements by the attendee.

21. The healers that are part of the Spirit Plant Journeys team function as spiritual guides and teachers. We offer ceremony for the purpose of spiritual communion. In order to operate ceremonies in accordance with Peruvian Law, we require that you also understand and agree to the following:

Peruvian Law concerning the illegal practice of Medicine: Ley N° 28538

(Spanish) Art. 290: “Será reprimido con pena privativa de libertad no menor de un año ni mayor de cuatro años, el que simulando calidad de médico u otra profesión de las ciencias médicas, que sin tener título profesional, realiza cualquiera de las acciones siguientes:

  1. Anuncia, emite diagnósticos, prescribe, administra o aplica cualquier medio supuestamente destinado al cuidado de la salud, aunque obre de modo gratuito.
  2. Expide dictámenes o informes destinados a sustentar el diagnóstico, la prescripción o la administración a que se refiere el inciso

(English) Art. 290:
Any person simulating a doctor or health care professional without a professional title will be punished with incarceration no less than one year and no more than four years for realizing any of the following actions:

  1. Advice, diagnosis, prescription, or administering or applying any means destined as health care, even if it is offered without charge.


  2. Offering tests or information designed to support the diagnosis, prescription, or administration in reference to number 1.



Spirit Plant Journeys is not a medical facility and no health care is practiced under its direction. Its owners and employees are not health care professionals and do not practice health care of any form.
We do not offer:

  1. Advice, diagnosis, prescription, or administer or apply any means destined as health care, even if it is offered without charge.
  2. Tests or information designed to support a diagnosis, prescription, or administration in reference to number 1.

 

Retreat Cancellation Policy

Payment for your retreat reflects a retreat package organized, arranged, and booked by and through Uplift Heal Awaken LLC, which is split into two equivalent installments, one paid upfront, and one paid upon your arrival onsite at your retreat. The first installment, shown in this initial booking, reflects your commitment to your retreat experience, and is non-refundable.

This includes, but is not limited to, any issue or inconvenience that affects your ability to come on retreat or participate on retreat that is within your control (i.e. failing to receive COVID-19 test & results in a timeframe that allows you to enter Peru, missed flights, negative COVID test result, etc.) From the moment that you pay this installment and receive from us any documents, travel logistics assistance, one-on-one calls, etc., you have begun receiving and consuming your retreat package, reflected in this initial installment.

The second installment for your retreat package will be paid via credit card onsite on the first day of your retreat.

It is at the discretion of the Spirit Plant Journeys team, upon review of your medical questionnaire and registration details, to allow you to participate in plant medicine ceremonies while on retreat. After receiving and reviewing your medical questionnaire, and participating in a one-on-one call with you, the Spirit Plant Journeys team will inform you as soon as possible whether or not you have been cleared to participate in ceremony.

Any denial of participation in ceremony is entirely at the discretion of the Spirit Plant Journeys team. If the Spirit Plant Journeys team decides that for your or the group’s safety, or for any other reason deemed necessary, you are not permitted to participate in ceremony, refunds of any kind will not discussed, considered, or given by Uplift Heal Awaken LLC, under any circumstance.

The only circumstance in which we will be able to offer flexibility regarding this first installment is if you are unable to travel to the location of your retreat due to circumstances arising from force majeure, i.e. a global pandemic spurring international border closures or an airline shutdown. If an event of this nature occurs and renders you completely unable to come on retreat, for reasons totally and completely outside of your control, Uplift Heal Awaken LLC will credit your first installment amount towards a future retreat package or online course program, minus a 10% administration fee.