Kapitari Retreat Registration

Please note – this registration form is for our 7 day Ayahuasca Group Retreat. This retreat costs $650

To begin the booking process please fill in the registration form below. Once we have received and approved your registration form we will confirm your place on the retreat and request payment of the deposit (you should receive confirmation within 48 hours).

If you are intending to come on the retreat with a friend or partner then we must receive a registration from each of you. If we do not receive a registration you will not be put on our reservation list and will not be able to attend the retreat.

Very important – Please do not book your flights until you have had your booking confirmed by Andy or Sarah. Sometimes retreats fill up before we are able to update the website, so a retreat may be fully booked even if the website says otherwise.

Ayahuasca in and of itself is a very safe medicine. However, when taken in conjunction with certain other medications, drugs or health conditions can be dangerous or even life threatening. It is therefore important to be open and honest on the registration form below. This is for your own safety.

Retreat Date:
Do you want to do the Machu Picchu Adventure? (Tour description here) :  yes no
Country of residence:
Email Address:
Sex: Male Female 
Name & phone no. of emergency contact:
Dietry Restrictions:
Do you have any allergies or dietry requirements we should be aware of? (If yes, please give details below):

Have you ever suffered or currently suffer from any of these conditions? (Check all that apply)

High Blood Pressure Circulatory Problems Irregular Heartbeat Heart Surgery Heart Attack Aneurism Mental Disorder Schizophrenia Clinical Depression Bipolar Diabetes Stroke Epilepsy Anxiety Disorder OCD Infectious Disease Autism 
If you checked any of the above, or are suffering from any other illness, please provide further details.
Are you currently taking any medication? (If yes, please give details)
Do you have any history of drug use/abuse? (If yes, please give details)
What are you hoping to receive from working with ayahuasca?
Please add any further comments or questions if you have any.
How did you hear about Kapitari?

Please leave this field empty.

Please note: A very small number of registrations have not been getting through to us for some reason. If you have not received a response to your registration within 3 days, please email us at [email protected]