Country of Residence
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What would you like to accomplish in ceremonial work at Dawn of Eden®?
Programs dates you prefer?
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Are you currently taking any medications? YesNo
If yes, please explain
Are you currently taking any drugs or psychoactive substances? YesNo
Have you ever experienced any of the following conditions? High blood pressureHeart attacksCirculatory problemsClinical depressionMental disordersSchizophreniaEpilepsyDiabetesStroke
Do you have any experience with non-ordinary states of consciousness? YesNo
Have you ever participated in the ceremonial use of Ayahuasca, Huachuma (San Pedro), Peyote, Iboga, Mushrooms or other shamanic plants? YesNo
Do you regularly practice yoga or meditation? YesNo
Do you have any physical limitations of which we should be aware? YesNo
Do you prefer vegetarian food? YesNo
Do you have any special dietary needs? YesNo
*** Please read Terms and Conditions and click the “I Agree” button to submit your application then send a recent photo to email@example.com complete the application process.
Terms and Conditions
Your acceptance for Ayahuasca or Huachuma ceremonies facilitated by Dawn of Eden® is incumbent upon your agreement to the terms and conditions set forth here.
For the purpose of setting forth these terms and conditions Dawn of Eden®, the business, and its entire staff to include Dan Reynolds, the owner, will be considered “The Facilitators” and the person making the application will be considered “The Applicant”.
The Applicant acknowledges having read the Terms and Conditions in its entirety including “Medications and Health Concerns” and agrees to accept all such terms and conditions as part of his or her acceptance into Dawn of Eden® ceremonies.
The Facilitators recommend The Applicant seek the consul of a medical professional regarding his or her physical and mental fitness for participation in the Ayahuasca and/or Huachuma ceremonies provided by Dawn of Eden®. It is incumbent upon The Applicant to assume this responsibility. If The Applicant determines this to be unnecessary, The Applicant must assume full responsibility and all risks for their participation in Dawn of Eden® ceremonies having judged themselves mentally and physically fit to do so.
The Applicant understands that The Facilitators will do their best to insure his or her safety, comfort and security but The Applicant accepts full responsibility for any loss of personal property or any personal injury suffered during the course of their program.
The Applicant agrees they may elect to not participate in all of the ceremonies provided by The Facilitators during their program but refunds will not be made for any of the ceremonies in which he or she elects to not participate. The Applicant further acknowledges that he or she has the option to participate in any of the planned activities or outings during their program but no refunds will be made for any activities in which The Applicant elects not to participate.
The Applicant understands that he or she is responsible for all international and in-country airline costs which are apart from the costs associated with Dawn of Eden® programs.
The Applicant agrees that in the unlikely event it becomes necessary to cancel a program due to circumstances beyond their control The Facilitators will issue a full refund of The Applicant’s program fees.
The Applicant agrees that should there be any dispute between his or her relationship with The Facilitators; the dispute should be arbitrated between the parties in question. If a resolution can’t be reached between The Applicant and The Facilitators, The Applicant agrees that a resolution will be arbitrated by the Peruvian courts located in Iquitos, Peru.
The Applicant understands that a non-refundable $500 deposit is required at the time an application is approved in order to book the program desired. The balance of the program must be paid in full at least 45 days in advance of the program in question.
The Applicant understands that he or she may receive a refund for any Dawn of Eden® program, less the program deposit which is non-refundable. Dawn of Eden® must receive requests for a program fee refund in writing not less than 45 days in advance of the program so that another applicant might be considered for that slot. Partial refunds will not be given should a participant decide to participate in only parts of their program or decides for whatever reason to leave a program early.
The Applicant understands that mapacho (sacred tobacco) will be used for protection, opening chakras, and as a means to convey intention during ceremonial work with Ayahuasca and Huachuma.
The Applicant understands that The Facilitators have the right to decline their application for participation in Dawn of Eden® programs.
I agree to these terms and conditions and will sign a hardcopy of this agreement before participating in ceremonies.
Medications and Health Concerns
Those suffering with schizophrenia or other mental or psychotic disorders should not consume Ayahuasca.
If you have high blood pressure or a heart condition or if you are receiving treatment for any health condition it is advisable to consult your doctor before drinking Ayahuasca. It is also advisable to consult your physician if you are taking prescription medications (including antibiotics).
Medical consultation is essential if you are taking Prozac or another antidepressant that affects serotonin levels. SSRIs (serotonin selective re-uptake inhibitors) such as found in certain antidepressant drugs block the re-uptake of serotonin in the brain. MAOIs (monoamine oxidase inhibitors) such as found in Ayahuasca inhibit the breakdown of serotonin. The combination can lead to excessive levels of serotonin in the brain. Seek the advice of a medical professional but be aware that SSRI medications typically need to be reduced gradually and can take up to six weeks to clear the body.
Over-the-counter medications to avoid include antihistamines, cough syrups, dietary aids (including those containing ephedrine or ephedra), and certain herbal medicines such as St. John’s Wort).
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