Application to join Radical Rest Retreat June 28-30

Thank you for your honesty so we can create the safest and most appropriate container for our women's retreat, including any necessary preparation and integration support you may need.

Please be honest with yourself regarding whether now is a good time for working with psychedelic medicines. If you need help, I am here to support you through this decision-making  process. Psychedelic experiences are very safe, but they are not for everyone, nor for all people at all times.

Thank you for answering honestly. Together we'll create safer spaces to journey together in. 

Noemi 

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Email *
First & Last Name
Age
Are you a (cis or trans) woman (or non-binary person) who considers yourself a "sister"?
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How did you hear about this event?
How many times have you used psychedelics (not including cannabis)
Please link to your social media account so we can verify your identity:
How many times have you used mushrooms?
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How many times have you used cannabis?
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Please click any that apply. They don't automatically disqualify you from participating but do require extra consideration. 
Please share about any checked boxes above to help us understand if this retreat is right for you or how we can best support you in it. 
Are you currently on any medications, supplements, or recreational drugs that may affect your ability to safely  participate in a psychedelic experience?
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 Feel free to add more about that...
Do you have a safe and relatively stable home environment, and are not subject to active or ongoing  domestic violence? (Homelessness and not having a safe space to return to after an experience may not  provide the necessary setting for proper integration.) 
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Do you have clinically significant acute anxiety, acute trauma, or a history of traumatic or difficult life events that have not been addressed therapeutically?
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Has a trusted health professional ever advised you to cease or otherwise limit consumption of cannabis,  psychedelic medicines, or using altered states practices?
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Have you ever had a severe, adverse reaction to using cannabis or other psychedelic medicines, either  physically, emotionally, or otherwise?
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Have you ever obsessed over an idea, conspiracy, or belief in a way that has caused difficulties in your life?
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 Feel free to share more about the above questions if you'd like. 

Have you ever experienced extreme paranoia or anxiety, panic attacks, or other extreme negative experiences  while using cannabis, any psychedelic medicines, or during any other time in your life that required a significant  intervention?  

(Paranoia, anxiety, and panic are not uncommon under the influence of a psychedelic. I know how to support these experiences safely, however, it is very helpful to know beforehand if this has happened in the past or is a  common experience for you.)

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Have you ever seen or heard things or people that weren’t there, at any time, or after the effects of a psychedelic or cannabis should have worn off?
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As you contemplate attending this experience, or when checking in with yourself right before it begins, are  you extremely anxious? (Again, it is normal to be a little nervous, but if you feel shaky or unsafe, please let us  know.)
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Have you ever been or are you currently involved in any legal proceedings? Criminal or civil?  (Due to societal misunderstandings about psychedelics and cannabis, it may not be safe to participate in our  program if you are involved in any legal proceedings).
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What meal plan would you most like?
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Do you have any allergies I should be aware of?
Would you like the option to spend the night in a private room ($777) or sleepover-style ($444) or camping ($444) ? There are 3 private bedrooms available. 
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Anything else you think we should know about? Use the space to include any additional comments, questions,  concerns, and major allergies so we can do our best to accommodate. 
Do you confirm that the answers you gave above are all true? Please sign your name by typing it below if so.
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