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Private Medicine Retreat

November 14 - 16, 2024
- With Beana Bern

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1 Price

Add extra nights: nights after

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    Sunrise Suite (Dorm)

    The Sunrise Suite is Rootstock’s ‘bunkhouse’ and dorm-style dwelling.  Up a short, steep flight of stairs you’ll find a cozy...

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    $2,500
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    Sunset Suite (Private Room)

    The Sunset Suite is a queen sized room up a short, steep staircase in Rootstocks community cabin, also known as...

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    $2,800
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    Oasis Cabin (Private Cabin)

    The Oasis Cabin at Rootstock Retreat is the nest to book if you’re wanting your own private cabin for your...

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    $3,000

2 People in your group

Guest 1
First Name*
Last Name*
Email*
Gender*
Guest 1
First Name*
Last Name*
Email*
Gender*
After completing this form, emails will be sent to everyone in your group to complete their information.

3

4 Personal Information

Many people are waiting to come and experience a medicine retreat. If you're open to Beana welcoming in 1-3 additional people please let her know! The price decreases per each additional participant. 1 = $2500 2 = $2000 3=$1750 4=$1500

5 Reasons for attending Rootstock

What challenges or opportunities in your life are guiding you to come do this work at Rootstock?
Day/Month/Year

6 Health & Medical History

If you have been diagnosed with any of the above conditions, please check all that apply
Please list any and all medications and daily supplements that you take. Medicine work is contraindicated with some medications so please be thorough.
No need to write your whole life story here. Just note some of the 'Big Ones' that you hold onto and don't overthink this too much.
Check all that apply

7 Emergency Contact Information

First and Last Name, Relationship

8 Food Preferences & Allergies

Check all that apply

9 Additional Information

Share any details you can about where your ancestors come from and any details you think are relevant about your lineage and ancestry,
Share any artists, genres or tracks that are important to you. There is no guarantee that these tracks will be woven into your playlist but we appreciate knowing what music moves you.

10 Terms & Conditions

By checking this box and typing my name in the field below, I attest that I have read and understand all of the above written medical information and have openly disclosed all requested health and medical facts. I attest that the information provided above is true and complete, to the best of my knowledge. I understand that falsifying or omitting any relevant information may be grounds for denying my attendance at the retreat for which I am applying, or denying me access to psilocybin mushrooms while on the retreat, with or without a refund, at the sole discretion of Rootstock Retreat. I hereby waive, release and hold harmless Rootstock Retreat from any and all liability or responsibility for all injuries and/or damages or claims which may occur in the event I do attend the retreat. By checking this box and typing my name in the field below, I understand that if I choose to attend a Rootstock Retreat without tapering off my medications that there is a significant chance that my experience with psilocybin mushrooms will be reduced. I also understand that I should not make any changes to my use of prescribed psychiatric medications until I have consulted with a licensed medical professional. I agree to review all emails and attachments that are sent to me by Rootstock Retreat as they will contain important information regarding my scheduled retreat. I also agree that I am submitting this application on my own behalf, that all information included is in regards to my own personal information, and that I am not submitting this application on behalf of anybody else.
I hereby assume all of the risks of participating in any/all activities associated with this event, including by way of example and not limitation, any risks that may arise that are not caused by direct negligence of the parties to be waived. I certify that I have sufficiently prepared or trained for participation in this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no mental or physical health-related reasons or problems which preclude my participation in this activity. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I waive, release, and discharge from any and all liability, including but not limited to, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, the following entities or persons: Rootstock Retreat and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers; (B) Idemnify, hold harmless, and promise not to sue the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity. I acknowledge that Rootstock Retreat and their directors, officers, volunteers, representatives, and agents are not responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I acknowledge that this activity may involve a test of a person’s physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for employees. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I certify that I have read this document and I fully understand its content. I am aware that this is a release of liability and a contract and I agree to it of my own free will.
Supplementary Products Exclusion: Participants acknowledge and agree that these Fees presented and payable pertain solely to Services and Offerings, and will not include the cost of any plant-medicines or similar products (collectively, "Supplementary Products") which may be provided, offered, or distributed by a Commercial User, or any other party, in connection with Services or Offerings. Retreat Guru shall bear no responsibility or liability in connection with any provision, offering, or distribution of Supplementary Products, and is not a party thereto. All capitalized terms used herein shall carry the same meaning as assigned to them in Retreat Guru's Terms of Service.

11 Donate

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Rootstock Medicine Retreat Scholarship Fund
Help us keep this powerful and effective healing modality available to everybody who needs it. Donations made to this fund will ensure that Rootstock is able to welcome the people here who will be best served by this work, regardless of their means. Thank you so much for sharing your healing and supporting our mission to serve.

12 Payment

Payments made through Retreat Guru do not include the cost of: plant medicine, psychedelics or similar products
There will be no additional charges for this retreat.
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