1. Do you understand that ceremony may involve vomiting, nausea, crying, fear, shaking, visions, emotional release, silence, confusion, or intense inner experiences?*

2. Do you agree to follow the guidance of the facilitators and curanderos during ceremony?*

3. Do you agree not to leave the ceremony space without informing a facilitator?*

4. Do you agree to maintain respectful emotional, physical, romantic, and sexual boundaries with all guests, facilitators, curanderos, and staff?*

5. Are you comfortable receiving simple supportive touch, such as a hand on the shoulder, only with your consent?*

6. Are you willing to follow Kairos preparation guidelines around food, alcohol, recreational substances, medication safety, sexual activity, media/stimulation, and rest before and after the retreat?*

7. Do you understand that Kairos is located in a natural jungle environment with rain, mud, insects, wildlife sounds, humidity, darkness, and uneven terrain? *

8. Are you comfortable being in a remote natural setting outside a major city, with periods of silence and reduced stimulation?*

9. Do you have any fears around darkness, caves, insects, animals, isolation, or jungle environments?*

10. If YES please descrbe and explain *

11. Do you have any food allergies, dietary restrictions, eating disorder history, or food-related concerns we should know about? *

What kind of support will you have after returning home? Select all that apply.*

Do you have someone you can call if you feel emotionally vulnerable after returning home?*

Can you give yourself a few quiet days after returning home for integration?*

At home, are there current issues involving abuse, manipulation, coercion, betrayal, addiction, violence, or fear?*

What would you like us to understand about you that has not yet been asked?*

Is there anything you feel afraid to share because you think it might affect your acceptance?*

I confirm that the information I have provided is accurate and complete to the best of my knowledge.*

I understand that Kairos may request further information, a preparation call, medical clearance, or psychological/psychiatric clearance before accepting my booking.*

I understand that final acceptance is only confirmed after my questionnaire has been reviewed and Kairos has approved my participation.*

Date Of Signature*