Please read the “Terms and Conditions” and “Medical Advice and Precautions” before you sign the form.

Your Details







confidential Disclosures

The following information will be kept in confidence by the organisers.

Are you taking any medications?

Have you sought medical advice regarding these medications or conditions with regard to your participation in this event?

Are your advisers happy for you to take part?

Are you happy to take part, taking full responsibility for your participation?

Emergency Contact



Terms & Conditions


 I have read your terms and conditions and agree to abide by these. (Terms and Conditions can be found at the end of this document)

TERMS AND CONDITIONS

Bookings are made on the understanding that you (and your group members if relevant to this booking) will abide by these terms and conditions. “The Organisers” are Brett & Naho Ebsary of “Maya Retreat Iquitos”, Peru and their agents, staff and assistants. “The Participant” is the person named on the Booking Form for this event. Where this is a group leader making a booking on behalf of a group of individuals the term “Participant” also includes all members of the group leader’s party and the leader agrees to accept responsibility for them.

1. The Organisers reserve the right to accept or decline a Participant booking at any time.
2. The Participant agrees to take part in a programme at Maya Retreat , including its plant ceremonies.
3. The Organisers will do their utmost to ensure the safety and comfort of the Participant within the remit of this programme. The Participant, in turn, agrees to exercise caution and consideration for him or herself and for others during this event, including at the venue and in other environments, and indemnifies the Organisers against claims for injury, loss, damage, misadventure or inconvenience at all stages.
4. The Participant has made confidential disclosures regarding medical conditions and/or use of medications. The Organisers agree to keep these in confidence unless required by law to divulge them and/or for the resolution of any dispute. The Participant agrees to inform the Organisers of any change in circumstances.
5. The Organisers have recommended that the Participant, prior to entry into this Agreement, seeks and obtains health or medical advice as to the effect of plants and herbal medicines singly and in combination with any medication they are taking. The Participant avows that he or she, having done so or deemed it unnecessary, is in a physical and mental condition appropriate to the activities described in this brochure and agrees to participate at his or her own risk. The responsibility for taking accurate and timely health precautions, professional medical advice, and for acting upon this (or otherwise) is solely with the Participant.
6. The Participant has the option of joining any, all, or none of the activities on offer at Maya Retreat and taking any, all or none of the plants available, and should he or she wish to take them does so voluntarily, taking full responsibility for his or her actions.
7. The Participant has been advised that ayahuasca is a visionary plant and is clear on the meaning of this. Reference sources have been provided which may describe the ayahuasca experience and the Participant has conducted other research where appropriate to satisfy him or herself of the effects that may be produced. The liability is with the Participant.
8. The Organisers agree to supply transportation, plant medicines, accommodation and food as part of this event during the dates given and within the guidelines supplied (e.g. the ayahuasca diet). The Organisers are not responsible for travel or other costs outside of this programme or for flight cancellations or other interruptions or travel disruptions and no refunds,
reimbursement or payments-in-kind will be made for these.
9. The Organisers reserve the right to make changes to the itinerary or costs of this programme if necessary or to cancel this event if need be. In the unlikely event that the programme is cancelled a full refund will be made to the Participant of fees paid by him or her to the Organisers. The Organisers are not, however, responsible for other costs which the Participant may incur or have incurred such as transportation or the purchase of any goods or materials.
10. The Organisers will do their best to help with any special requests or needs that the Participant may make or have but are not beholden to do so and the Participant understands that such requests may need to be paid for by the Participant separately to this programme and its contents and that he or she may also have to make his or her own arrangements (e.g. for travel outside the programme) and at his or her own cost.
11. If the Participant withdraws from this event the programme or retreat fee will be refunded in full provided that his or her cancellation is made in writing and reaches the Organisers before 30 days prior to the first day of the programme, save for the Participant’s deposit which is non-refundable in all circumstances.
12. The Participant will not hold the Organisers liable for damages, injuries, losses, accidents or delays, including willful or negligent acts, failures to act or breaches of contract by any parties which supply goods or services for this event.
13. The Participant indemnifies the Organisers against loss or damage, including that resulting from insufficient or improperly issued passports, visas or other travel documents.
14. The Participant has been advised to take out suitable medical and travel insurance for their journey and this event, covering personal accident, medical expenses, losses, repatriation costs and all other expenses which might arise as a result of loss, damage, injury, delay or inconvenience. Group leaders must also ensure that they have adequate public liability insurance to cover themselves and their group in case of accidents or other misfortunes. The Organisers are not liable for such expenses.
15. The Participant – and his or her family – understand that the Amazon rainforest and this programme represent travel of a unique nature and will hold the Organisers and its associates, representatives and employees blameless for any injury or ailment occurring during this programme or afterwards. The onus is on the Participant to explain this programme to others if need be and to ensure their agreement and understanding.
16. The Participant agrees to show respect for the environment he or she is in and to act with courtesy and dignity towards other group members and local and native people at Maya Retreat and during external activities. Should the Participant commit any illegal act or should his or her behaviour adversely affect other people’s enjoyment of this event he or she may be asked to leave the Centre and shall have no entitlement to complaint or refund and will bear any expenses as a result of
this.
17. The Participant agrees that any photographs, videos, film or notes taken by the Organisers during this event in which the Participant may feature may be published by the Organisers and gives consent to this without consideration unless prior written agreements are entered into.
18. The Participant agrees to acknowledge Maya Retreat and this programme (including email and website addresses) in any production of his or her own which may result from his or her participation in this event, whether this is of a commercial or non-commercial nature. This may include but is not limited to books, articles, films, videos, CDs, tapes, DVDs and productions using on-line resources such as YouTube and Facebook which are intended or available for public broadcast or diffusion. Such acknowledgement must not, however, be presented as an endorsement by the Organisers of any materials produced by the Participant unless this is expressly agreed in writing.
19. The relationship between the Participant and the Organisers is governed by Peruvian law and in the unlikely event that a controversy arises which cannot be resolved between us both parties agree to the exclusive jurisdiction of the Peruvian Courts in Iquitos, Peru.
20. The Participant has read, understood and voluntarily signed this document and agrees that no representations, statements or inducements have been made by the Organisers for him/her to take part in this programme or to sign this Agreement. By signing the Participant waives certain legal rights, including the right to sue.

MEDICAL ADVICE AND PRECAUTIONS

Ayahuasca (Banisteriopsis caapi) contains monoamine oxidase inhibitors (MAOIs) in the form of harmine and harmaline. We suggest, therefore, that you consult your medical advisor if you are taking medications which may affect your serotonin levels (known as serotonin selective re-uptake inhibitors or SSRIs) as the combination of MAOIs and SSRIs can lead to higher levels of serotonin in the body. SSRI medications generally require 6 weeks to clear the body and should be reduced gradually.
If you are taking antibiotics or anti-depressants or receiving other medical treatment it is also good practice to see your doctor and ask his or her advice about the effects of your medication in combination with ayahuasca. There may be no problem but it is best to check. Non-prescription medicines such as antihistamines, dietary aids, amphetamines and their derivatives and some herbal
remedies (e.g. those containing ephedrine, high levels of caffeine or other stimulants) should be discontinued for at least a week prior to and following work with ayahuasca. Please check with your herbalist or homeopath as even otherwise innocuous remedies like St John’s Wort/hypericum may not be suitable in combination with ayahuasca.
Avoid all chemically-based recreational drugs, in particular MDMA (ecstasy), cocaine, speed and heroin. The use of non-chemical recreational drugs such as marijuana should also be discontinued for a period of at least two weeks prior to and following work with ayahuasca. Ayahuasca and the diet that goes with it are not always ideal in combination with certain medical conditions (e.g. some
stomach, heart, colon or mental health problems, etc) so, again, please check with your doctor and take his or her advice about participation.