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BOOK A JOURNEY
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APPLY BELOW FOR YOUR HEALING EARTH AND PLANT SPIRIT MEDICINE RETREAT
Date of Birth
Current Address Including City / Town
In order to confirm your identity, please upload a copy of a government-issued photo ID.*
Upload supported file (Max 15MB)
Place of Birth
Emergency Contact Name
Emergency Contact Phone Number
Emergency Contact Relationship To You
Please list any past or present physical health conditions.
Please list any past or present psychological health conditions. Some examples include: schizophrenia, paranoia, depression, anxiety, multiple personality disorder, bipolar disorder, PTSD, ADD, ADHD, self harm, eating disorder, panic attacks, obsessive compulsive disorder, etc.
Are you taking any prescription drugs for these / other conditions?
Have you ever been diagnosed or treated for any addiction?
Do you have a family history of addiction (drug, alcohol, or other)?
Are you currently taking any SSRIs (Selective Serotonin Reuptake Inhibitors)?
Do you have any allergies or sensitivities (food, medication, other)? Please share your reaction(s) to them as well.
What is your current / preferred diet?
Do you have a history of trauma? If so, please give some background on the experiences in your life.
Lastly please share your intention for wanting to participate in this type of journey experience. Take your time with this question as your intention plays a major role in your journey experience.
As the next step in the registration process, a Zoom call will need to be scheduled
I do NOT agree.
What type of journey experience would you like to explore?
BESPOKE (Only you.) $9800 CAD
COUPLES (You and your partner / person of choice). $7900 CAD Total
INDIVIDUAL (Would be part of a group setting.) $1650 CAD Each
What days would you prefer your SAKRD journey?
Weekends (Friday - Sunday)
Weekdays (Monday - Wednesday)
I declare that the information I’ve provided is accurate and complete.
I want to subscribe to the newsletter.
Thank you for your application.
NOT READY TO APPLY BUT WANT TO KNOW MORE?
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