Additional Information Form • Mineral Shaman

Additional Information for Peru Retreat

Please help us with a bit of additional information. Thank you!

General Information

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Please provide the number you will be using while in Peru, if you know it. If you plan to buy a pre-paid local SIM card, make sure you get us that number once you have it.

Best Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please provide the names and phone numbers of two emergency contacts.

The Following Questions Are Relevant to our Horseback Riding Day

Date of Birth(Required)

Please provide your height and weight.(Required)

Describe the experience you have had with horses.(Required)

This is so that we can correctly match you with a horse.

Additional Health and Food Questions

Please list all medications, supplements, herbs you will be taking during the retreat.(Required)

If none, please write "none."

Please describe any known allergies or sensitivities, and what symptoms you experience, if any.(Required)

This could be to anything--foods, medications, chemicals, etc. If you don't have any, write "none."

If you do have allergies and/or sensitivities, do you carry an EpiPen?(Required)

If you keep an EpiPen on hand, please bring this with you.

Please describe any food preferences or specific dietary requirements.(Required)

If you eat a special diet, please explain so that we can plan for this.

Flight Information

If you don't yet have your flight information, just skip these.

Arrival Flight to Cusco

Please provide the flight number and date/time of arrival in Cusco. As a reminder, you may arrive any time on August 3rd.

Departure Flight from Cusco

Please provide the flight number and date/time of departure from Cusco. We will be checking out of our Villa in the morning on August 13th.

Other Items

Is there anything you want to share with our group while on retreat?

If you would like to share some of your own medicine, please let us know. Examples might be: helping to cook, guiding practices, etc.

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