Design Your
Soul Adventure

I cannot wait to adventure with you, !

To make sure this journey delights both your human AND your soul selves, please take some time to respond to the following questions. This will help me plan our upcoming adventures.

Please include area/country code
Please include full name, phone, email, relationship to you, and country of residence.

Intention + Preferences

(This can change, but it gives us ideas for the types of activities, rituals, and other adventures we'll concoct.)
I'm most excited to.... *
Check all that apply!

Medical Questions

The following questions help us understand what self-healing modalities and physical activities we can prepare for you.

I.e. Are you wearing masks when in public, maintaining physical distancing, staying relatively isolated and/or socializing only within a specific "pod," etc.
(Including, but not limited to: history of seizures, heart problems, allergies, asthma, lack of mobility, etc.)
(e.g. food/smoking/drugs/etc.)

The Menagerie Collective LLC Client Agreement

We are pleased you have decided to embark on this journey with us, and it is our goal to guide you through a safe, positive, and transformational life experience. We may ask for certain precautions or preparations to be adhered to prior to your travel dates. We ask you to abide by these precautions, restrictions, and this Agreement for your safety and in order to ensure a positive experience. We take your safety seriously and hope you understand the precautions and restrictions accordingly.

Privacy Note: The information you provide us will be kept in strict confidence. Unless required by law or for resolution of any dispute, we will not disclose, sell, or in any form communicate your personal information to a third party.

Terms and Conditions

  1. I am aware that this retreat with Lola and/or Tigre Pickett (“The Menagerie Collective LLC”, "TMC") may involve the use of Huachuma (San Pedro), Psilocybin Mushrooms, MDMA, and/or other healing medicines (e.g. Kambo/Sapo, etc.). I understand that taking these medicines may involve emotional and physical reactions, and I agree to take part and abide by the terms and conditions in this document and/or other instructions given orally or in writing.
  2. I am aware that these are psychoactive medicines. These psychoactive medicines affect the central nervous system by influencing the release of neurotransmitters, and often induce a dreamlike state. The plants are entheogens that cause changes in perception, emotional state of mind, thought, and mood that depart from ordinary reality.
  3. I understand that failure to follow guidelines in this document or avoid anything not compatible with the medicinal plants is my responsibility. I have made the necessary confidential disclosures about my health, medications, use of herbal supplements, and drug use to help ensure my health and safety. I understand that by signing this Agreement I accept full responsibility for participating in a workshop with TMC and do so at my own risk.
  4. In return for being allowed to participate in TMC activities and all related activities, including any activities incidental to such participation (“Participant Activities”), I release and agree not to sue TMC or its officers, employees, sub-contractors, sponsors, agents and affiliates (“The Menagerie”) from all present and future claims that may be made as a result of me, my family, estate, heirs, or assigns for property damage, personal injury, or wrongful death arising as a result from my participation in Participant Activities wherever, whenever, or however the same may occur.
  5. Prior to entry into this Agreement, I have sought medical advice as to the effect of these substances in combination with my health, any medication, herbal supplements, vitamins, or drugs I use.
  6. I promise that I am in a physical and mental condition appropriate for ingesting these substances and understand my responsibility for taking accurate and timely health precautions in consultation with a doctor.
  7. I agree to notify TMC in writing of any health conditions and have consulted with a doctor prior to signing this Agreement. I agree to promptly notify TMC in writing of any change in my medical circumstances.
  8. I agree that I will not participate if taking any medication prescribed by a doctor, anything purchased over the counter, or any herbal supplement or vitamin because of the serious health risks and/or possibility of death.
  9. I promise that my doctor has read this agreement and understands the risks involved but has advised me that it is safe for me to participate in the Workshop given my current medical condition.
  10. I promise that I have not taken any medications for an amount of time deemed safe and appropriate by my doctor.
  11. I agree I will not take any over the counter products/medicines, vitamins, or herbal supplements of any kind for at least 14 days before and 14 days after my ceremony.
  12. I agree I will not drink alcohol or take any drugs (including marijuana) at least 2 days before and 2 days after my ceremony.
  13. As a female, I promise to advise TMC staff if I am premenstrual or menstruating. Because of the direct link between hormonal changes and one’s emotional state, TMC staff will better their ability to create a positive environment for you and everyone else with this knowledge.
  14. Should I decide to leave a ceremony held by TMC prematurely, for any reason, TMC is not responsible for any reimbursement of payment.
  15. TMC is not responsible for and does not consent to any activities we deem dangerous. Dangerous activities include but are not limited to tree climbing, interaction with wildlife, skirting edges, and any other activity not reasonably prudent.
  16. We reserve the right to physically restrain or expel anyone who presents a threat to the safety of themselves or others.
  17. I promise not to remove any Shamanic tools, plants, or plant infusions from TMC.
  18. TMC reserves the right to expel without refund any guest who breaks any of the stated rules and regulations.
  19. TMC will do its utmost to ensure your safety and comfort within the area of others during the ceremony. I agree to indemnify TMC for any injury or loss of personal property I cause while at the retreat.
  20. TMC is not liable for the injury or loss of personal property of any guest that may occur during or after the immersion. By purchasing an immersion with TMC and signing this Agreement, I express full understanding of any responsibility for risks I may encounter during a workshop. I absolve TMC, its owners, and employees of any responsibility.
  21. Entire Agreement: This Agreement contains the entire agreement of the parties and there are no representations (oral or written), inducements, or other provisions other than those expressed within this Agreement. All changes, additions, or deletions must be in writing and signed by all parties.
Enter your full name, first and last, as you have entered it on this application like so: /s/John Doe
Format: MM/DD/YYYY