Ayahuasca Retreat Registration Ayahuasca retreat Registration form Select the length of your retreat: 5-day short retreat 10-day full immersive retreat Select the event you wish to book:*Note: If you select an event which is currently full, you will be placed into its waiting list and notified when a space frees up. April 27 - 6, 2026 (10 days) $1790 - Ceremonies led by Don Carlos August 10 - 19, 2026 (10 days) $1790 - Ceremonies led by Don Carlos September 7-16, 2026 (10 days) $1790 - Ceremonies led by Don Carlos October 5 - 14, 2026 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo) October 19 - 28, 2026 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo) November 23 - December 2, 2026 (10 days) $1790 - Ceremonies led by Don Carlos January 11 - 20, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo) January 28 - February 6, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo) February 13 - 22, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo) Select the event you wish to book:*Note: If you select an event which is currently full, you will be placed into its waiting list and notified when a space frees up. April 27 - May 1, 2026 (5 days) $890 - Ceremonies led by Don Carlos May 1 - 5, 2026 (5 days) $890 - Ceremonies led by Don Carlos August 10-14, 2026 (5 days) $890 - Ceremonies led by Don Carlos August 14-18, 2026 (5 days) $890 - Ceremonies led by Don Carlos September 7-11, 2026 (5 days) $890 - Ceremonies led by Don Carlos September 11-15, 2026 (5 days) $890 - Ceremonies led by Don Carlos October 5 - 9, 2026 (5 days) $890 - Ceremonies led by Maestro Sina October 9 - 13, 2026 (5 days) $890 - Ceremonies led by Maestro Sina October 19 - 23, 2026 (5 days) $890 - Ceremonies led by Maestro Sina October 23 - 27, 2026 (5 days) $890 - Ceremonies led by Maestro Sina November 23 - 27, 2026 (5 days) $890 - Ceremonies led by Don Carlos November 27 - December 1, 2026 (5 days) $890 - Ceremonies led by Don Carlos January 11 - 15, 2027 (5 days) $890 - Ceremonies led by Maestro Sina January 15 - 19, 2027 (5 days) $890 - Ceremonies led by Maestro Sina January 28 - February 1, 2027 (5 days) $890 - Ceremonies led by Maestro Sina February 1 - 5, 2027 (5 days) $890 - Ceremonies led by Maestro Sina February 13 - 17, 2027 (5 days) $890 - Ceremonies led by Maestro Sina February 17 - 21, 2027 (5 days) $890 - Ceremonies led by Maestro Sina Deposit non-refundability and even cancellation akcnowledgement* I am aware that the booking deposit is non-refundable. However any deposit can be transferred to another date if done at least 30 days before the originally booked event begins. The deposit can also be transfrerred to another person for free any time. In case the even in cancelled, the organizer issues a full refund of any depodsits, but is not responsible for covering any losses due to event being cancelled. In order to prevent any losses, a travel insurance or refundable flight tariff is recommended. Basic informationYour name:* Name Surname E-mail* Enter Email Confirm Email Gender:* Male Female Age:*Residency* City AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Passport number*If you don't have your passport yet, please fill "0" and give us your passport number later.Emergency contact (name, phone number):*Health conditionWhat is your current health condition?*Do you currently suffer from any of the following health conditions? very high blood pressure severe diabetes schizophrenic disorder heart disease or any condition previously diagnosed indicating vulnerability to the heart epilepsy and other seizure related conditions infectious or contagious disease suicidal ideation use of MAO inhibitors or anti-psychotic medication mental illness drug addiction diagnosed terminal illness such as cancer Any medicines or supplements that you are currently using:Allergies:Please list any recreational drugs you are using regularly:*Enter "none" if you are not currently using any recreational drugs.Are you currently pregnant? Yes No I understand that ayahuasca and all other sacred plants are purgatives and dangerous to consume while pregnant. If I become pregnant before the beginning of the tour, I understand that I am responsible for notifying Feather Crown and that I will not be able to ingest ayahuasca or any other sacred plant during pregnancy. I also understand that I will not be entitled to a refund.Feather Crown Health Screening and Full Disclosure:No supplements, no medications" policy*This retreat involves the ingestion of plant medicines that may be contraindicated with certain medical conditions, medications, or substances. All herbal supplements, natural medicines, and medications (prescription and over-the-counter) taken within 30 days prior to the retreat, as well as during the retreat, must be fully disclosed to Feather Crown before the retreat begins. No medications, supplements, or natural remedies may be taken during the retreat without the express written permission of Feather Crown. By completing this application, you confirm that all information provided is true, complete, and current, and that you have fully disclosed all physical and psychological conditions, as well as all medications, supplements, and substances you are taking. I agree to the Feather Crown Health Screening and Full Disclosure Feather Crown Medical Responsibility and Liability WaiverBy checking the box below and typing my name, I confirm that: I have read and understood all provided medical and safety information I have fully disclosed all requested health and medical information All information I have provided is true and complete to the best of my knowledge I understand that: Falsifying or omitting relevant information may result in denial of participation, with or without refund, at the sole discretion of Feather Crown Ayahuasca and other plant medicines may be dangerous or life-threatening if combined with certain conditions or substances Feather Crown is not a medical facility Its owners, staff, employees, and agents do not practice Western medicine and are not licensed medical doctors I voluntarily assume full responsibility for my participation. I hereby waive, release, and hold harmless Feather Crown, its owners, staff, employees, and agents from any and all liability, claims, damages, or injuries that may occur in connection with my participation.*By checking the box below and typing my name, I confirm that: I have read and understood all provided medical and safety information I have fully disclosed all requested health and medical information All information I have provided is true and complete to the best of my knowledge I understand that: Falsifying or omitting relevant information may result in denial of participation, with or without refund, at the sole discretion of Feather Crown Ayahuasca and other plant medicines may be dangerous or life-threatening if combined with certain conditions or substances Feather Crown is not a medical facility Its owners, staff, employees, and agents do not practice Western medicine and are not licensed medical doctors I voluntarily assume full responsibility for my participation. I hereby waive, release, and hold harmless Feather Crown, its owners, staff, employees, and agents from any and all liability, claims, damages, or injuries that may occur in connection with my participation. I have read, understood, and agree to the Medical Responsibility and Liability Waiver Please type your name in CAPITAL letters:*Food, accommodation and transportationPreferred diet:* Normal Vegetarian Vegetarian eating fish Vegan Any special requirements for your diet?Preffered type of accommodation:* Private room for 1 person Private Room for 2 people (2 beds) shared among friends or family Let us know if there is somebody specific you want to share your room with:Private transport from Quito/airportPlease check the following fields if you want us to organize private transport for you on the 1st day of the retreat, and/or the last one. We can pick you up at your hotel in Quito, or at the Mariscal Sucre airport near Quito, or in Tababela (a town close to the airport). Please note that the price may differ according to how many people are requesting transport, but will not exceed $120 USD per person. Quito/aiport -> Feather Crown ($50 USD per person, departure 8-9 AM) Feather Crown -> Quito/airport ($50 USD per person, departure 9:00 AM) Work with the plantsDo you have any previous experience with Ayahuasca? If yes, what were the results?*What would you like to achieve and what are your expectations?*Referral (first time guests only)How did you hear about Feather Crown? If it was from a website, which one? Thank you for helping us to understand how people find us.Message to the organizers:Anything that you want to add:Make sure we receive your registration:After you hit the submit button, you should receive an immediate confirmation email. If you don't receive the confirmation email within few minutes, something went wrong with your submission and you need to resend it. Make sure you fill all the obligatory fields, otherwise it won't let you send the form. You can always contact us at info@feathercrown.com if you have any problem.
