Ancient stone walls and massive rocks at Machu Picchu with a clear blue sky.

Coming back to Love
The mystical Heart and the Crack in the Skull

Below is our application form. Take your time and fill in the necessary information.We’re here to answer any questions you might have about the retreat. Feel free to reach out!

A condor flying in front of a rocky mountain landscape.

Name

First Name

Last Name

Preferred Name

Gender

Birthday

YYYY

Nationality

Occupation

Adresse

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone (Home)

(###)

###

####

Phone (Mobile)

(###)

###

####

Health and Medical History #1

Do you have any medical conditions we should be aware of? (e.g., heart issues, epilepsy, chronic illnesses)

Health and Medical History #2

Are you currently breastfeeding?

Health and Medical History #3

Have you been diagnosed with any mental health conditions? (e.g., depression, anxiety, PTSD, bipolar disorder, psychosis)

Health and Medical History #4

Are you currently taking any medications?

Experience with Psychedelics

Have you worked with psychedelics before?

Intentions

What is your primary intention for attending this retreat? (e.g., healing, self-discovery, spiritual exploration)

Emotional Readiness

How would you describe your current emotional and psychological well-being? (e.g., stable, navigating challenges, in crisis)

Dietary Needs

Do you have any allergies or dietary restrictions?

Understanding and Consent #1

Are you aware of the potential risks and benefits of working with psychedelics?

Understanding and Consent #2

Do you agree to follow the retreat’s guidelines ?

Cancellation and Refund Policy for "Coming Back to Love" Retreat

This retreat is a profound and life-changing experience that requires full commitment from all participants. As such, we have a no-refund policy to ensure dedication and to cover the significant costs involved in preparing for and hosting this retreat. Non-Refundable Payments: All payments made for the retreat are non-refundable. This policy is in place due to the fixed costs associated with venue booking, facilitator arrangements, and other preparations. Participant Transfers: If you are unable to attend for any reason, you may transfer your spot to another participant. This must be arranged and confirmed with us at least 14 days before the retreat start date. Force Majeure: In the event of unforeseen circumstances beyond our control (e.g., natural disasters, travel restrictions), we will offer participants the option to transfer their booking to a future retreat or receive partial credit toward a future experience. This credit will be calculated based on non-recoverable expenses already incurred. Travel Insurance: We strongly recommend purchasing comprehensive travel insurance to protect against unexpected disruptions, such as illness, travel cancellations, or personal emergencies. By registering for this retreat, you acknowledge and agree to this policy. We appreciate your understanding and commitment to this transformative journey.

Coming back to Love
The mystical Heart and the Crack in the Skull

Thank you for registering for
the "Coming Back to Love" Retreat!
This is a confirmation for your interest. In the next step we clarify your attendance!

We're thrilled to welcome you on this transformative journey. Prepare to reconnect with the essence of love and explore profound spiritual practices in the serene
Mountain House Retreat.

Coming back to LoveThe mystical Heart and the Crack in the Skull

Thank you for registering for the "Coming Back to Love" Retreat!This is a confirmation for your interest. In the next step we clarify your attendance!

We're thrilled to welcome you on this transformative journey. Prepare to reconnect with the essence of love and explore profound spiritual practices in the serene Mountain House Retreat.

Coming back to Love
The mystical Heart and the Crack in the Skull

Thank you for registering for
the "Coming Back to Love" Retreat!
This is a confirmation for your interest. In the next step we clarify your attendance!

We're thrilled to welcome you on this transformative journey. Prepare to reconnect with the essence of love and explore profound spiritual practices in the serene
Mountain House Retreat.