Sheffield, MA: Amazonian/Tibetan Primordial Breathwork w/ Ceremonial Cacao

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Dietary Restrictions? *
Allergies? *	Food, medicine, specific insects, etc.? List "none" if you have no allergies.
Describe ALL Medical Issues *	Enter "none" if you have no issues.
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Do you have a history of epilepsy or a neurological condition? *	Yes No
Do you have any heart or blood preasure conditions? *	If yes, please share details.
Do you have a history of mental illness? *	Have you ever been diagnosed and/or hospitalized due to mental illness? If no, please state "none".
Describe all Surgeries and/or Hospitalizations in the last 5 years. *	State "none" if not applicable.
Please list all supplements & pharmaceutical mediations. *	List all by name, dosage and reason for taking. State "none" if you don't take medications.
Any pharmaceuticals you recently stopped taking? *	List all medications you stopped taking in the last year and what they where taken for.
Additional Comments or Special Needs?	Any additional health & care information not listed above that we should be aware of.
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Terms, Conditions, Release of Liability & Assumption of Risk *	I accept the terms and conditions.Read Terms and Conditions Here
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.

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