2026 Star River Simple - Multiple Template

December 31, 2026

- With Robin Flynn and Darcy Kopas

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1 Price

Select a price.

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CAD $0.00 – Program Price

Number of Guests:

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CAD $0.00 – Price

Number of Guests:

2 People in your group

Guest 1		First Name* Last Name* Email* Gender*
Guest 1		First Name* Last Name* Email* Gender*

3 Participant Info

First Name *
Last Name *
Email *
Phone
Address
Address 2
City
State/Prov.
Zip/Postal
Country
Email newsletter	Please send me the email newsletter
Comments or Special Needs
Gender *
Birth Date *
Special Diet *
Dietary notes, please explain: *
Emergency Contact Info
Medical Issues	Enter "none" if you have no issues
Are you a Pachakuti Mesa Practitioner? *	If yes, what trainings have you participated in?
Have you worked with sacred plants before? *
Do currently drink alcohol? If so, how many drinks a week? *
Please list any recreational drugs you currently use. *	Enter "none" if you do not currently use any recreational drugs.

4 Medical History

Physical Health Details and Medications *	Include diagnosis history, any past and current medications including dosage and time on meds.
Heart Health Details and Medications *	Include diagnosis history, any past and current medications including dosage and time on meds.
Mental Health Details and Medications *	Include diagnosis history, any past and current medications including dosage and time on meds.
Recent Injuries or Active disabilities *	Please provide details of any recent injury or active disability.
Medical History: Please include all formal diagnoses received from doctors through your lifetime and any concerns you have personally regarding your health. *

5 Terms and Conditions

2026 Cancellation Policy *	Retreat Cancellation and Refund Policies: All cancellations must be made in writing to Visionary Hearts, providing retreat date and date of cancellation. $500 deposit is non-refundable or transfereable. Cancellation 60 days or more before Retreat start date a full refund minus $100 processing fee. Cancellation 45-59 days before Retreat start date a 50% refund. Cancellation 45 days or less before Retreat start date: No Refund or Credit will be offered. No Refund or Credit will be offered for: No show, late arrival, early departure of retreat, personal injury/illness (with the exception of Covid), weather, travel delays, flight interruptions or schedule conflict. If you are traveling from abroad, Visionary Hearts, highly recommends that you purchase cancellation or travel insurance which may insure you against unforeseen illness, injury, job loss, inclement weather and more. There are no exceptions to the above cancellation, refund or credit policies.

2026 Cancellation Policy *

Retreat Cancellation and Refund Policies: All cancellations must be made in writing to Visionary Hearts, providing retreat date and date of cancellation. $500 deposit is non-refundable or transfereable. Cancellation 60 days or more before Retreat start date a full refund minus $100 processing fee. Cancellation 45-59 days before Retreat start date a 50% refund. Cancellation 45 days or less before Retreat start date: No Refund or Credit will be offered. No Refund or Credit will be offered for: No show, late arrival, early departure of retreat, personal injury/illness (with the exception of Covid), weather, travel delays, flight interruptions or schedule conflict. If you are traveling from abroad, Visionary Hearts, highly recommends that you purchase cancellation or travel insurance which may insure you against unforeseen illness, injury, job loss, inclement weather and more. There are no exceptions to the above cancellation, refund or credit policies.