Course Registration Form

Wed, Aug 12, 10a-12p PT Dancing with Plants: Embodied Plant Meditation with Rebekah Olstad

THIS IS THE REGISTRATION AND SCHOLARSHIP FORM FOR BLACK & INDIGENOUS IDENTIFIED STUDENTS
Full scholarships to this class are available on a first come first serve basis for the black & indigenous communities. Each person must submit a registration form and we ask that folks PLEASE SIGN UP FOR ONLY ONE CLASS SCHOLARSHIP so we can make space for as many people as possible
Student Name *

First Name Last Name
Gender Pronoun(s) *
Birth Date *

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E-mail *
Phone Number *

Area Code Phone Number
Address *

Street Address

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City State / Province

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Which course are you registering for? *
REFUND POLICY: We do not offer refunds or scholarship credits for our classes. *

I have read and understood this policy
Are you a past student? *

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Racial/cultural/ethnic background (PLEASE NOTE THIS SCHOLARSHIP & REGISTRATION FORM IS FOR BLACK & INDIGENEOUS IDENTIFIED STUDENTS) *
Do you have any medical or accessibility needs that we need to know? *
For the purposes of creating a safe space for the group, in what other ways do you self-identify that you'd like to specifically and explicitly let us know?
What is your background, if any, in holistic medicine, herbalism, curanderismo and/or ancestral medicine? *
What interests you about this class? *
What is your intention or what do you hope to complete in this class? *
Anything else we should know about you?
How did you hear about the class? *

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Wed, Aug 12, 10a-12p PT Dancing with Plants: Embodied Plant Meditation with Rebekah Olstad

Full scholarships to this class are available on a first come first serve basis for the black & indigenous communities. Each person must submit a registration form and we ask that folks PLEASE SIGN UP FOR ONLY ONE CLASS SCHOLARSHIP so we can make space for as many people as possible