Retreat Application Form (Netherlands)

In order to apply for the retreat, please fill in the form below. All information provided is kept confidentially and we rely on your honesty and accuracy to help us better evaluate whether our psychedelic retreats are a good option for you.

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Application form

Name & Surname

First

Last

Phone (include country code)

Which retreat are you applying for?

Please mark any that apply to you.

Taking anti-anxiety medication

Medical heart condition

Psychosis, Schizophrenia, or Bipolar Disorder

Pregnant or breastfeeding

NONE OF THE ABOVE

How did you hear about us?

By submitting this form, I confirm that I have read and understood the Privacy Policy and consent to the collection, processing and storage of my personal data for the purposes of the retreat. My data on this form will be stored securely and retained only until the end of the retreat program. I understand that I can withdraw my consent at any time by using the contact details provided.

I consent

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Contact Us

Email: contact@consciousgrowth.eu

Book a call with us

Legal Note

Taking psychedelic truffles in our retreats is subject to a registration process. Please consult the FAQs for a list of contraindications. Conscious Growth does not offer therapy or treatment for physical or mental health conditions during the retreats.

In accordance with Dutch law, we use exclusively psilocybin truffles that are legal across the country. You can read more about the legal aspect here.

APPLY for a Retreat
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Psilocybin Retreats in the Netherlands
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Privacy Policy