Intakeformulier Psilocybine retreats (ENG)

Intake form Psilocybin retreats

De Hoorneboeg is not opposed to retreats where psilocybin is used in treatment or trauma healing in the broadest sense of the word. However, De Hoorneboeg does not allow psilocybin retreats that have a recreational character. To ensure the safety of participants, visitors and employees of De Hoorneboeg, we ask the organizer to answer to our questions below so that the management of De Hoorneboeg can properly assess whether the application is appropriate within the guidelines and objectives. Thank you in advance.

After submitting this form, you will receive a copy by email.
Your name*
Your name
E-mailadres*
E-mailadres
Name company or organisation*
Naam bedrijf of organisatie
Website*
Website
Which organization or entity organizes the retreat and bears final responsibility?*
Which organization or entity organizes the retreat and bears final responsibility?
How much experience does this organization have in organizing psilocybin retreats?*
How much experience does this organization have in organizing psilocybin retreats?
Who is leading the retreat? How much experience does this person have in leading psilocybin retreats?*
Who is leading the retreat? How much experience does this person have in leading psilocybin retreats?
Are there references regarding previous retreats from retreat centers?*
Are there references regarding previous retreats from retreat centers?
How many participants do you expect for the retreat?*
How many participants do you expect for the retreat?
How many supervisors are there for this number of participants?*
How many supervisors are there for this number of participants?
Do the supervisors themselves also use psilocybin during the ceremonies? In what dose?*
Do the supervisors themselves also use psilocybin during the ceremonies? In what dose?
De Hoorneboeg sets the condition that at least 1 supervisor is completely sober during the ceremonies. What is this person's name and role? And does this person have an emergency response certificate?*
De Hoorneboeg sets the condition that at least 1 supervisor is completely sober during the ceremonies. What is this person's name and role? And does this person have an emergency response certificate?
Does anyone from the guidance have a medical background?*
Does anyone from the guidance have a medical background?
How many psilocybin ceremonies will be held during the retreat?*
How many psilocybin ceremonies will be held during the retreat?
With what substance will be worked? In what dose?*
With what substance will be worked? In what dose?
Do you have any questions or comments?
Do you have any questions or comments?