Heart of the Forest - Attendee Registration

1

Legal Name* This field is required.Please enter your legal first and last names

First Name

Last Name

2

Preferred Name* This field is required.Please tell us how you would like us to refer to you

First Name

Last Name

3

Email* This field is required.Please enter your email address

example@example.com

4

Phone Number* This field is required.

Please enter a valid phone number.

5

Emergency Contact* This field is required.Please enter the legal first and last name of an emergency contact

First Name

Last Name

6

Please enter your emergency contact's phone number* This field is required.

Please enter a valid phone number.

7

Which dates are you signing up to join us?Select a weekend from the menu below

8

Do you have experience with Grandfather medicine?* This field is required.

YESNO

9

Do you have experience with Rapé?* This field is required.

YESNO

10

Do you have experience with Cacao?* This field is required.

YESNO

11

Do you have experience with Sananga?* This field is required.

YESNO

12

Have you attended one of Etheric's immersions or ceremonies before?* This field is required.

YESNO

13

Are you willing to commit to the 7-day diet before entering ceremony?* This field is required.If you have not read the "Preparation" page of the website, please do so now.

14

Please write out any specific health concerns or needs that you have.* This field is required.Please disclose any medical diagnoses whether you think they are important or not.

15

Are you currently taking any prescription medications or supplements?* This field is required.If so, please list them here. Your honesty = our safety.

16

What is your intention with attending this immersion?* This field is required.Please be specific.

17

The next step is submitting your $250 deposit to reserve your spot! Please send your deposit to @highvibes on Venmo, or $crystalchildvibes on CashApp (as friends and family, or else I will need to charge tax as well). Once completed, Etheric will contact you to schedule a pre-ceremony consultation phone call. Below, please write: the platform you sent your donation on, the account name it was sent from, and the days of the week that are generally best for you to have a consultation. Please contact me directly if you need to use a different payment method. Click the submit button below only after these last steps have been completed, and your spot for Heart of the Forest will officially be reserved!