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Gender * Male Female Other For rooming purposes Requested Roommate Please share your intention or purpose * The reason that motivates you to go through this experience How did you hear about us? * A friend Internet Search Website Advertisement Other Why did you choose Casa del Sol? * What is your current occupation? * How is your household composed? * I live alone I live with my parents I live with my partner I live with my partnet and children I live as a single parent with children I live in a community Have you ever taken plant medicines before? * Yes No Ayahuasca, San Pedro, Yopo, Peyote, Bobinsana, etc. Please specify your previous plant medicine experience: * What plants, where, when and how was it. How would you describe your current state of overall health? * (mental and physical) Have you ever in the past, or are you currently dealing with any of the following conditions (mild or severe) If you want to provide more details, please do so: Have you ever suffered from back pain, spinal defects or spinal disorders? * Yes No Please specify your back pain, spinal defects or disorders * Have you ever suffered from headaches, migraines and/or neck pain? * Yes No Please specify your headaches, migraines and/or neck pain * Have you ever had problems with your muscular system? * Yes No Please specify the problems in your muscular system * Do you have any bone fractures? * Yes No Please specify your bone fractures * Did you or do you have any joint pathologies? * Yes No Did you or do you suffer from osteoporosis? * Yes No Please explain in detail in which areas specifically * Have you ever suffered a stroke or heart attack, even a mildest one? * Yes No Please specify your experience with a stroke or heart attack * Did you undergo a serious heart surgery? * Yes No Please specify the heart procedure you went through * Do you suffer from any blood pressure condition? * Yes No Please specify your blood pressure condition * Do you suffer from anxiety and/or depression? * Yes No Please specify your condition in detail. Have you ever been medicated? * Do you suffer from insomnia? * Yes No Please specify your condition in detail. Have you ever been medicated? * Have you ever taken non-prescribed drugs? * Yes No e.g. Cocaine, ecstasy, heroin, etc. Which drugs, the intake method, how often and when last used? * Have you taken any prescribed medications within the last 12 months? * Yes No What medications, how regularly, for what conditions and when did you stop taking them? * Do you have any infections or viruses? * Yes No e.g. HepatitisB/Lyme/HIV What infections or viruses? * e.g. HepatitisB/Lyme/HIV Have you or any of your family members suffered from mental disorders? * Yes No e.g. Schizophrenia, Psychosis, Bipolar Please specify who and what mental disorders * e.g. Schizophrenia, Psychosis, Bipolar Do you have any physical disabilities or limitations? * Yes No Please specify what physical disabilities or limitations * Have you ever had any surgical intervention or any body part replaced with a prosthetic limb? * Yes No Please specify any surgery or prosthetic limb procedure * Are you or could you be pregnant? * Yes No Have you ever had an abortion or miscarriage? * Yes No Do you have any allergies? * Yes No e.g. Food allergies like gluten/nuts, non-food allergies like animal hair/skin, hay-fever, etc. Please specify what allergies * Are you allergic to any medications? * Yes No e.g. iodine, aspirin, sulfa, etc. Please specify what medications allergies * Do you have any special dietary requirements? * Yes No e.g. vegan, vegetarian, dairy free, etc. Please specify your dietary requirements * What is the nature of your daily activities? * e.g. sitting in front of the computer, lifting loads, driving, etc. Do you practice any sports or physical training regularly? * Yes No Please describe your physical condition in detail * Do you have any type of spiritual practice in your daily life? * Yes No Yoga, tai chi, meditation, mindfullness, etc. Please tell us more about your spiritual practice * Do you express yourself through some creative or artistic way? * Yes No Music, dancing, painting, drawing, writing, etc. Please tell us more about your creative or artistic expression * Is there anything else we may need to know? * The more information you share about yourself helps us to have a better understanding of how to accompany and assist you Emergency Contact * Emergency Contact Relationship * Emergency Contact Phone * Emergency Contact Email * Do you have a private travel/medical insurance? * Yes No Travel/Health Insurance Info If yes, please provide us the name of your travel/health insurance, policy number and contact number in case of an emergency. If not, we can help you arrange one before your arrival Email newsletter Terms and Conditions I hereby declare that I have read carefully and completed the above questionnaire in detail.
I am aware that any activity in the CASA DEL SOL, complex without supervision, and without disclosure of any defect or ailment can endanger my health.
In the event of a change in my health, I undertake to notify CASA DEL SOL as soon as possible.
I hereby declare that apart from the details provided, I am healthy and fit to attend a retreat at CASA DEL SOL (and have nothing I know of a medical limitation that prevents me from attending a retreat at CASA DEL SOL).
If I do not report immediately to the staff of CASA DEL SOL of any change to my current health or physical condition, then any injury or damage, caused as a result of this change will be my own responsibility. Since this is my sole responsibility, I will not have any complaints against CASA DEL SOL or any of the staff. I will not hold responsible CASA DEL SOL of any liability for any damage caused to me. Cancellation Policy The payment of your retreat deposit is 100% refundable if your application is approved and you decide to cancel 70+ days before the start date.
Your full deposit is maintained to be reschedule to another retreat up to 30 days before the start date. Discount code 
