Heart of the Desert Registration
Your seat in this experience is only confirmed upon completion of this form and payment of deposit donation.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Emergency Contact
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Have you read over all of the information on the landing page for this experience?
Yes
No
Will this be your first time attending Heart of the Forest/Heart of the Desert?
Yes
No
Will this be your first time sitting with Grandfather?
Yes
No
Who is Grandfather?
Will this be your first time sitting in a shamanic ceremony?
Yes
No
Will this be your first time attending one of Etheric's ceremonies?
Yes
No
IMPORTANT MEDICAL INFORMATION
For your safety, please answer all questions honestly.
Please select any of the listed conditions that you have experienced, be it currently or even once in the past.
High Blood Pressure
Low Blood Pressure
Heart Conditions
Cardiac Issues
Epilepsy
Seizures
Aneurysm
Schizophrenia
PTSD
Physical, Sexual, Emotional, Mental, or Spiritual Abuse
Drug Addiction
Diagnosed Depression
Panic/Anxiety Disorder
Diabetes
Suicidal Ideation
Psychosis
Please describe any other medical/health concerns that you have.
Please list any food or plant/herb allergies that you have. (We will prepare vegan meals for this experience and want to be able to cater to everyone's needs.)
We want to ensure that we have safe meal options for everyone, thank you!
Are you currently taking any prescription or over-the-counter medications?
Yes
No
List any specific substances (pharmaceuticals, over-the-counter, recreational substances, supplements, etc.) that you have taken or plan to take within 4 weeks of ceremony.
YOUR HONESTY IS NECESSARY TO ENSURE YOUR SAFETY
Are you willing to commit to a 1-week "diet" in preparation of this experience? This would include cutting out processed foods, most meats, dairy, recreational drugs & alcohol, etc. (If not, then this experience is not for you)
Yes
No
I have concerns about this
What are your reasons for feeling called to this ceremony?
Let us know why you're attending, and what you want to get out of this experience!
Thank You!
The last step is now to pay your deposit donation Below. We will be reaching out to you at a later date to schedule a phone consultation.
Reserve Your Spot!
*
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USD
Submit your nonrefundable $200 deposit donation here.
SUBMIT
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