WHM WORKSHOP AND KAMBO RETREAT
If you have any questions before signing up and filling this form please contact us at email@example.com
Thank you, for considering joining one of our Immunity retreats and workshops. Please fill out this application form as completely and honestly as possible so we can determine if participating in the Intensive would be beneficial for you. The information you provide may be used to ensure your health and safety during the process.
What experiences have you had with medicines and entheogens such as ayahuasca, peyote, kambo, iboga, mushrooms, etc.? Please give a full history including dates of use.
What is the current state of your health? Please disclose in full detail any problems or conditions you may be experiencing.
If you have any illnesses or conditions, which ones are due to family history and/or genetic disposition?
Do you have or have you ever had problems with your heart, kidneys or other organs?
Are you currently taking or have you recently been taking any conventional medicines?
Do you have a history of depression or other forms of mental illness? Are there any cases of mental illness in your family?
Are you taking anti-depressants, methadone, thyroid medication or other heavy medicines?
What health issues have you experienced in your life?
Have you ever had any surgeries?
Do you have or have you had an addiction to drugs, food, alcohol, medicines, etc.?
Have you ever had any issues with high/low blood pressure?
What are your objectives, intentions and expectations from the Kambo ceremonies?
Please check the box if you understand you must submit a non-refundable payment of $500.00 (USD) if your application is accepted in order to reserve your spot in the retreat *
Yes, I understand.
How would you prefer to submit payment if you are invited to participate?
CREDIT CARD (16% Tax will be added to total if payment is by card)WIRE TRANSFER ($40.00 transfer fee will be added to total)
Please check the box if you have read the entire site and are committed to completing the Workshop and Retreat once you begin. *
Yes, I have read the entire website and commit to completing the WHM Workshop and KAMBO Immunity Boost Retreat at Prana Boutique Hotel, Tulum, Mexico.
Please carefully read the following statements and check the boxes if you fully understand, accept and agree to all the statements:
1. The WIM HOF METHOD has no affiliation with any of the therapies given during the KAMBO retreat. They are considered two separate methods to increase the immune systems efficiency but are unrelated to each other and for legal reasons will be assigned as 2 separate events in a row.(Wim Hof Method workshop on day 1 and Kambo retreat on day 2, 3 and 4.)
2. The WIM HOF METHOD is NOT meant to heal a specific physical or mental disease. It is only meant to be a supplementary therapy to any professional medical treatments.
3. The KAMBO ceremonies are NOT meant to heal a specific physical or mental disease. They are only meant to be a supplementary therapy to any professional medical treatments.
4. If I have any doubt about the potential incompatibility between Kambo and my current medical treatment, I will consult my doctor.
5. Kambo is a natural unprocessed product.
6. By participating in the Kambo retreat, I am consenting to small burns being applied to my skin.
7. I take responsibility for the messages received from the Kambo Spirit during and after the Intensive. I understand Kambo's effect is mirroring what I need to see and understand about myself.
8. The objective of the WIM HOF METHOD workshop and KAMBO retreat is to bring about a clear and positive mind, humility, happiness, discipline, calmness and responsibility in my everyday life and to help transform negative energies like fear, negative thinking and resistance.
9. The secretion of Kambo is a poison, but doesn’t act as such for the human body. The secretion doesn’t enter the body, but interacts with the lymphatic system and stimulates some brain receptors. I am aware the healing I will receive is the body healing itself.
10. The Kambo ceremonies I want to participate in are a spiritual ritual and NOT a substitute for medical treatments. Kambo is a sacred animal medicine and the purpose of this Retreat is spiritual and NOT medical.
11. If you selected Credit Card as a payment method, please fill your information below along with the amount and type of occupancies you would like, our Concierge will call back to confirm your reservation or contact you via E-Mail.
These prices are all inclusive: all meals, all the therapies and consultations, and a 5 night stay at Prana Boutique Hotel. (Airfare and airport transfers are not included).
Number of occupancies
Name on Card
Credit Card Number
By checking the box below and submitting this application form, I agree to take full medical and legal responsibility for any and all physical, mental, emotional and spiritual results stemming from my participation in the “IMMUNITY BOOST” WHM WORKSHOP AND KAMBO RETREAT at Prana Boutique Hotel and Retreat Center in Tulum, Mexico. *
Yes, I full understand, accept and agree with statements 1 through 11.