• When submitting the questionnaire you are committing to payment of the deposit of 30% if approved for participating.

    Participating persons



    Focus area

    What would you like to focus on?
    Enter the desired focus area in the field below

    Medical history

    Please give information if you have checked any of the boxes in the section above
    Please enter details about a recent injury and / or active disability

    Please provide details if you check any condition. Include diagnosis history, any past and current medications including dosage and time on meds. Enter "none" if none of the above have been checked.

    Other medicine

    As well as vitamins and other supplies

    Your family's health history

    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 Blue Morpho and that I will not be able to ingest ayahuasca or any other sacred plant during pregnancy. I also understand that I will only be entitled to a refund if the conditions of the Cancellation Policy are met.

    Because some of our tours involve the ingestion/utilization of sacred plants, we carefully screen each guest for their safety prior to attending a tour. All herbal supplements, natural medicines, and medications (prescription and over-the-counter) must be disclosed and subsequently approved for use by Spirit of Aya. All herbal supplements, natural medicines, and medications (prescription and over-the-counter) cannot be taken during the course of the tour without the express permission of Jacob Pedersen.You hereby agree that all information you provide in the application is correct and current and that you have disclosed all physical and psychological conditions as well as all herbal supplements, natural medicines and medications (prescription and over-the-counter) that you are taking. In some cases, you will be contacted personally by one of our staff to ensure that you are prepared for the experience. Spirit of Aya is not a medical facility and its owners, staff, employees and agents are not licensed medical doctors, psychologists, or psychiatrists. We do not practice medicine, diagnose, cure, or treat disease or illnesses. Instead, we function as spiritual guides and teachers and offer ceremony for the purpose of spiritual communion.Dietary & Behavioral Restrictions:Because some of our tours involve the ingestion of sacred plants, there are certain dietary and behavioral restrictions that must be followed. You will be advised of these restrictions when you arrive at the start of the tour. Some of our tours may have a different set of restrictions than contained in the following paragraphs. Each specific set of restrictions should be followed according to the corresponding tour.The amount of sweets that can be consumed on tour due to the use of sacred plants is limited. Consumption of alcohol and street drugs are not allowed at any time during the tour. Consumption of pork or pork products is not allowed during the entire tour and for 30 days after your last shamanic ceremony with sacred plants. You must also abstain from alcohol consumption and the use of street drugs for 7 days after your last ingestion of sacred plants.There is to be no sexual activity whatsoever between guests and/or staff during a tour. This includes married couples. This also includes masturbation. The environment demands abstinence from all sexual activity. Should you develop a sexual or romantic interest in another person, we request that you delay any physical displays or expressions of it until the tour is over. We are not attempting to create a moral or philosophical boundary but preventing the potentially dangerous crossing of energetic fields that can result from sexual or romantic behavior while engaged in shamanic ceremonies. Again, it is not important for the guest to understand this completely, but it is mandatory that the guest observe the rules.

    For your safety the Spirit of Aya shamans have a "no medications / vitamins / supplements policy" at the camp (with the exception of birth control pills and anti-malaria medication). Medical studies have shown that mixing medications and some supplements, with ayahuasca can be dangerous and potentially fatal. Spirit of Aya representatives are not licensed to give advice on prescription medications. If you are currently taking medications, please consult with your doctor before discontinuing any medications. If your doctor approves discontinuing your medications and has guided you on the weaning process then we require that most medications need to be fully stopped at least one month before the workshop begins so that your physiology can find safe balance without it. This stability period could be extended up to 6 months depending on the combinations and types of medications being taken.

    Previously Ayahuasca experience

    Please share any media or source that led you to Ayahuasca


    Only for first-time visitors
    Please enter the first name and last name of the guest who referred you to Ayahuasca

    Terms and Conditions

    By checking the box and typing my name in the field below, I attest that I have read and understand all of the above written medical information and have openly disclosed all requested health and medical facts. I attest that the information provided above is true and complete, to the best of my knowledge. I understand that falsifying or omitting any relevant information may be grounds for denying my attendance at the workshop for which I am applying, with or without a refund, at the sole discretion of Spirit of Aya International Inc. d/b/a Spirit of Aya, I hereby waive, release and hold harmless Spirit of Aya International Inc. d/b/a Spirit of Aya from any and all liability or responsibility for all injuries and/or damages or claims which may occur in the event I do attend the workshop.