SELVA MADRE HEALING CENTER
7 Day Ayahuasca Retreat

Thank you for booking a retreat with us – It’s a privilege to assist you on your path to healing.

Registration Form

To Register:
1. Fill out the registration form
2. Once you have reserved your space at Retreat Guru, please fill out this Intake Form.
3. Submit the Intake Form and our Intake Support Team will follow up to confirm your registration, request more information, schedule an intake call if needed, or let you know that a retreat with us is not a good fit at this time (in which case we will refund your deposit).
4. You will receive a “Registration Confirmed” email to proceed with the balance of your payment if your registration is confirmed through our intake process.

First Name
Last Name
Email
Phone
Address
City
State / Prov.
Country
Gender
Birth Date
Passport Number
Emergency Contact Name
Emergency Contact Phone Number 
Emergency Contact Email
Emergency Contact Country of Residence 
Emergency Contact – Relation
Emergency Contact

Are you traveling with someone?
What are your food preferences?
Dietary Needs & Allergies
Health Information
Other Comments or Special Needs
Terms and Conditions

Safety Waiver and Release form

Deposits

Thank you for submitting your registration form! Your information has been received successfully. We will review it promptly and get back to you shortly. If you have any urgent questions or concerns, feel free to reach out to us at contact@selvamadre.net. We look forward to connecting with you soon!
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SELVA MADRE HEALING CENTER
7 Day Ayahuasca Retreat

Dear Participant,
We are absolutely thrilled to inform you that your Ayahuasca retreat journey is about to unfold! In preparation for your transformative experience, we will be sending you a Retreat Information Pack document via email. This document is very important as it contains comprehensive details about your retreat schedule, the activities planned, boarding arrangements, and instructions regarding the payment of the remaining balance.
Please keep an eye on your email inbox for this essential document. It will provide you with all the information you need to ensure that your retreat experience is absolutely seamless and fulfilling. If you have any questions or require further assistance, please don’t hesitate to reach out to our team. We can’t wait to guide you on this profound journey of healing and self-discovery!
Warm Regards,
Selva Madre Healing Center

“Ayahuasca healing is not just about curing the body; it’s about nourishing the soul and awakening the spirit to its true potential.”

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