Application: Women's Wisdom & Plant Medicine Retreat
Welcome Beautiful Sister, I am so honored that you are intrigued in joining us for this very magical, transformative and special retreat at Farm of Life.

Unlike previous women's retreats, this retreat includes one night of ceremony with sacred visionary plant medicine which requires a strict screening process for your safety, and the well being of our group. It's really important that this retreat is fully aligned for you.

After filling out this form, we will book a complimentary 20 minute private discovery call, and you will receive the recording from a LIVE group call and Q&A (held in November) so that all your questions are answered before you make your decision and secure your space with a deposit. 

I am Looking forward to connecting with you in the jungles of Costa Rica!

Much love, Lacey

*** Please note that this information is confidential *** 
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Name *
Email Address *
City & Country  *
Date of Birth
How did you hear about the retreat? *
Is this your first time to Farm of Life ? *
What is most calling you to this retreat? Do you have an intention for the retreat? *
Which room are you interested in? *
Have you been part of any other women's retreats or gatherings? *
Are you currently committed to any spiritual practices which deepen your connection with nature, your inner self, Source, and which awaken the goddess within (yoga, meditation, prayer, affirmations, ritual, time in nature, dance, creative expression, reading, herbalism)? *
Do you have any health conditions? *
Do you have any food allergies?
Do you have a chronic heart condition or severely high blood pressure? *
Are you taking any pharmaceutical medications? *
Please Note: These are the medications that interfere with the plant medicine. Know that with enough time you can choose to come off the medication if necessary leading up to the ceremony so you can fully participate:

These types of medications can NOT be used along with Ayahuasca: 

other MAOIs; SSRI’s (any selective serotonin reuptake inhibitor); anti-depressant drugs and mood-stabiliers (Prozac, Seoxat,Zoloft, Effexor, Paxil, Welbutrin, Abilify, Aripiprazole); amphetamines (meth-, dex-, amphetamine, Adderall); medications to treat attention deficit hyperactivity disorder and narcolepsy; medications containing methlphenidate (Ritalin); anti-hypertensives (high blood pressure medicine); anti-Parkinsons drugs; appetite suppressants (diet pills); medicine for asthma, bronchitis, or other breathing problems; antihistamines, medicines for colds, sinus problems, hay fever, or allergies (Actifed DM, Benadryl, Benylin, Chlor-Trimeton, Compoz, etc.); central nervous system depressants; antipsychotics; antibiotics (currently or recently finished); Zyban to curb the urge to smoke; anti-malaria drugs, high-caffeine drugs; sedatives; narcotics;  and alcohol.  Please review this link for more information and a list of drugs. Please review this link for a great write up about it.   
*
Have you ever sat in a plant medicine ceremony before? If yes, please elaborate.  *
What is your current knowledge of the sacred jungle medicine, ayahuasca? *
What is your past experience with altered states of consciousness / plants / recreational drugs (mushrooms, marijuana, peyote, LSD, MDMA, etc)? *
Do you have a current or past mental condition? Have you or anyone in your family experienced schizophrenia, bipolar disorder and suicidal tendencies? Please explain. *
Do you or anyone in your family experience anxiety, depression,  seizure or panic disorder? If yes, please describe the severity? *
Will you be having surgery  within 2 weeks of the retreat, either before or after? (retreat dates: March 4th - 11th 2023) *
I affirm that all above answers are true and that these questions are asked for your best interest and safety. *
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