Healing at Home:

USA-Based Ayahuasca Retreats

for Veterans

A 4-Day Spiritual and Healing Journey

for Veterans, featuring Ayahuasca and Holistic Wellness.

USA-Based Ayahuasca Retreats

for Veterans

A 4-Day Transformation and Growth Journey

featuring Ayahuasca and Holistic Wellness.

First Name *

Last Name *

Phone *

Email *

Date of birth *

Select Your Retreat Date *

FEB 20 - 23, 2025

APR 17 - 20, 2025

JUNE 12 -15, 2025

Please indicate any specific medical condition that we should be aware of: *

Are you currently taking any medication? *

If you answer yes, what mediations are you taking?

Do you have a history of mental health conditions? *

If yes, Please specify

Have you ever participated in any form of Psychedelic Therapy? *

Do you have experience with breathwork? *

Do you have experience with meditation? *

Do you have experience with yoga? *

What do you hope to achieve by attending the Sacred Soldier retreat? *

Have you attended any similar retreats or programs in the past? If Yes, please describe: *

What are your hobbies or interests? *

Is there anything else you would like us to know about you? *

Please fill out the following details to help us ensure we provide you with the correct Sacred Soldier Merch: cap and t-shirt sizes.

Cap Size:

Small

Medium

Large

Extra Large

Tshirt Size

Small

Medium

Large

XL

Consent to Participate: I hereby consent to participate in the Sacred Soldier retreat and agree to follow all guidelines and procedures outlined for participants. *

Yes

No

Photo and Video Consent: I agree to allow Sacred Soldier to use photographs or video footage taken during the retreat for promotional or educational purposes. *

Yes

No

Data Privacy Consent: I consent to my data being used by Sacred Soldier for the purpose of organizing and facilitating the retreat. I understand that my information will be kept confidential and used in accordance with relevant data protection laws. *

Yes

No

Would you like to receive our newsletter and stay connected with us? *

Yes

No

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