Medicine of the Peace & Sacred Space - The Coming Home Gathering Application

Coming Home

A 2 Day Gathering to Reconnect with Your Inner Light
Thank you for your interest in our Coming Home Gathering!

This Sacred 2-day gathering is an invitation to reconnect with yourself and relcaim the luminosity that lives within. The Coming Home gathering weaves together powerful Indigenous Plant and Animal Medicine Ceremonies, Shamanic Rituals and Cleansings, Therapeutic Movement, and Sound and Energy Healing—all in devotion to helping you embody the vibrant yang energy of Sun and the fullness of your authentic expression.

If you’ve been feeling the call to reconnect with your inner fire and return to your own inner light, this is your invitation. Your soul already knows—it’s time to rise, and to come home to the brilliance that has always been yours.

Below is a health questionnaire to ensure you can safely sit within the various Sacred Ceremonies we will be faciliting during our gathering. Please answer all with honesty and integrity.

Thank you,

The Medicine of The Peace and Sacred Space Team
Contact Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Retreat Questionnaire
Do you have a history of mental illness, history of methamphetamine, cocaine, opiate use, or alcoholism? If yes, please explain.*
Are you taking prescriptions medications If so please list all medications.*
Have you had a stroke, brain hemorrhage, blood clot or aneurysm? If so please explain and list date of event.*
Do you currently use LSD or any other psychedelic substances? If so please list the substance and how often?*
Do you have any serious wounds internally or externally that have not yet healed, recent surgeries? Please list any and date of surgeries.*
Do you have an active eating disorder? If so, please explain.*
Are you currently pregnant or attempting to get pregnant?*

YesNo
Are you currently taking any of the following types of medications - Selective Serotonin Reuptake Inhibitors (SSRIs), Monoamine Oxidase Inhibitors (MAOIs), or Triptans?*

YesNo
Do you have a recent history of a stroke, heart attacks, and or have a pacemaker?*

YesNo
Do you have any serious heart problems, heart transplant, or taking medication for low blood pressure?*

YesNo
Do you use diuretics currently?*

YesNo
Have you had an organ transplant?*

YesNo
Are you diabetic and on medication?*

YesNo
Do you currently or in the past had severe cognitive disorders where you were not able to understand physical processes?*

YesNo
Are you taking immune system suppressant medications?*

YesNo
Have you had chemotherapy or radiation treatments within the last 4 weeks or will you be receiving treatments at least four weeks before retreat begins on April 3rd?*

YesNo
Do you have asthma? If so do you use an inhaler?*

Yes, I use an inhaler.Yes, I don't use an inhaler.No
What calls you to ceremony? Have you thought about your intention and what that maybe?*
Should be Empty:

Coming Home

Contact Information

Retreat Questionnaire