🌳 Rooted | 1-night Psilocybin Mushroom Ceremony

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1 Welcome

2 Choose Your Accommodation

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Ceremony Room

You will be provided a 4" memory foam mat. No private rooms are available for this ceremony.

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$650

$650

$650
Ceremony Room
You will be provided a 4" memory foam mat. No private rooms are available for this ceremony.

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3 People in your group

4 Optional Items

5 Participant Info

Mailing List *	Click to be added to our mailing list. This is required for updates about your retreat.
Birth Date *
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Occupation *
Address *
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City *
State/Prov. *
Zip/Postal *
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Phone *
How did you hear about us? *
Please explain: *
Ride Sharing *
Where will you be located? *	For example, "North Park, San Diego" or "Los Angeles Airport (LAX)"
Comments or Special Needs

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6 Ceremony Questions

Why are you interested in this ceremony? *	Please reflect on this question and share in 3-5 sentences.
Please describe your spiritual practice. *
Please describe your experience with psychedelics. *
Do you agree to prepare your mind and body at least 1 week before the ceremony? *	Yes! I will steer clear of substances and low-vibe food & environments leading up to ceremony.You will receive a preparation guide with how to prepare, once your application is approved. Post-ceremony "diet" is just as important.
Do you agree to arrive at the retreat center no later than 2pm on your arrival date? *	Yes! I promise to be on time. This ensures we can begin ceremony on time.
Do you agree to let us hold your phone and car keys for the duration of the gathering? *	Yes, please! I am choosing presence & happily taking a break from my tiny rectangle.We will hand them back to you if you desire them and it's safe. This is for general safety as well as helping you stay present to the experience. Your nervous system will thank you. Our gatherings are about pattern interruption.

7 Medical Questionnaire

Emergency Contact Info *	Please write the first name, last name, relationship, and phone number of your contact. (E.g., Joe Schmo, Brother, 123-456-7890)
Diet *	If you wish to select multiple options (e.g., dairy free AND gluten free), choose your primary diet, then add additional info below.
Diet Notes *	Please list any allergies. If you chose "other" please expand on that here. If no notes, write "none".
Do you have any other allergies? *	Yes No
Please describe. *
Do you or a family member have any history of psychiatric disorders (borderline personality disorder, schizophrenia, bipolar, psychosis, etc)? *	Yes No
Please list the diagnosis / diagnoses. *	Include relation if the diagnosis is not yours (e.g., mother). You're welcome to provide additional info here if desired.
Have you engaged in any intentional self-harm or had any suicidal thoughts in the last year? *	Yes No
Please explain. *
Have you recently had a intense emotional shock or grief, such a death of a loved one or a tough break-up? *	Yes No
Please explain. *
Would you say you have a significant amount of unresolved emotional trauma? *	Yes No
Please explain. *
Have you been diagnosed with PTSD? *	Yes No
Please explain. *
Are you currently taking any medication that affects your serotonin system (MAOI's, SSRI's, SNRI's, etc)? *	Yes No Due to the current research, many medications that act on the serotonin receptors are not compatible with psilocybin. Only make medication changes with the help of your doctor. Do not stop taking your prescriptions abruptly to join our ceremonies. If you believe your medication is not contraindicated, we will speak 1:1 with you.
Please list your medication(s). *	Please include dosage and length of time on medication(s).
Are you taking any other medications? *	Yes No
Please list your medications *	Please include dosage and length of time on medication.
Have you had a concussion in the last 6 months? *	Yes No
Please explain. *
Are you pregnant? *	Yes No
Please provide details. *
Do you have any heart, liver, or kidney conditions? *	Yes No
Please explain. *
Do you have any medical procedures planned within a month of the ceremony? *	Yes No
Please explain. *
Is there anything we should know about your mobility? *	Yes No Is there any way we can better accommodate you?
Please explain. *
Do you have any other medical conditions or issues? *	Enter "none" if you have no issues

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8 Terms & Conditions

Terms and Conditions *	I accept the terms and conditions.Please read the terms and conditions
Cancellation Policy *	I understand & agree to the cancellation policy for this ceremony.If your intake is not approved, you will receive a full refund. If you cancel before March 20th, your payment may be applied as credit toward a future Agape gathering. After March 20th, no refunds or credits will be issued for this ceremony.
Payments do not include the cost of plant medicines. *	I understand that payments made through Retreat Guru do not include the cost of: plant medicine, psychedelics or similar products. There will be no additional charges for this retreat.Supplementary Products Exclusion: Participants acknowledge and agree that these Fees presented and payable pertain solely to Services and Offerings, and will not include the cost of any plant-medicines or similar products (collectively, "Supplementary Products") which may be provided, offered, or distributed by a Commercial User, or any other party, in connection with Services or Offerings. Retreat Guru shall bear no responsibility or liability in connection with any provision, offering, or distribution of Supplementary Products, and is not a party thereto. All capitalized terms used herein shall carry the same meaning as assigned to them in Retreat Guru's Terms of Service.

9 Donate (Optional)

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Guest 1		First Name* Last Name* Email*
Guest 1		First Name* Last Name* Email*

1 Welcome

2 Choose Your Accommodation

Select an option*

Ceremony Room

3 People in your group

4 Optional Items

5 Participant Info

6 Ceremony Questions

7 Medical Questionnaire

8 Terms & Conditions

9 Donate (Optional)

10 Payment