2026 LWS New Member Intake Form

Luna Wolf Sanctuary New Member Intake Form

Let us know a few things about you before scheduling your Welcome Call.
Legal First Name*
Legal Last Name*
Preferred Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Your Age*
Current Occupation *
Where You Currently Reside*
Gender/Pronoun
(Optional)
Preferred Emergency Contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Acknowledge below, the following agreements with Luna Wolf Sanctuary (LWS).
I have read through the Lunawolf.org website and viewed some of the media content to get an initial impression of the community.*

I agree
I understand LWS practices are not medical or therapeutic in function and are LWS staff do not intend to treat or diagnose disease.*

I agree
I understand that LWS is a religious organization (church) and that members of LWS are first and foremost participating for spiritual/religious purposes.*

I agree
I understand that all LWS practices are for the purpose of serving its mission to provide safe containers for supporting the transformation process of discovering and manifesting our deepest truths. Our ceremonial sacraments, Grandmother Ayahuasca, Bufo, and Kambo serve as our essential guides in this process.*

I agree
Please describe in what ways you feel connected to the beliefs of Luna Wolf Sanctuary.*
Please explain how you heard about us and what has led to your interest in our ceremonial sacraments.*
Basic Health Questions: We do not turn people away for having health issues, but we need to ask for your safety and benefit. Careless circumstances can lead to the worsening of health issues, so please answer honestly.

(Your answers on this form do not necessarily disqualify you from participation, this is always evaluated on a case-by-case basis.)
Do you have any past experience with any entheogenic, plant, fungi, amphibian or psychedelic medicines?*

YesNo
If yes, please describe.*
Psychedelic or not, please describe any mystical, expanded, or altered states of consciousness you have experienced in the past.*
Have you ever been diagnosed with any psychiatric illness?*

YesNo
If yes, please list any and all diagnosis.*
Are you prescribed any medications or taking any supplements?*

YesNo
If yes, please list all prescribed medications or supplements.*
Please also list the length of time you have been prescribed.*
Do you have a history of any addictions or any present dependencies?*

YesNo
If yes, please describe your relationship to these circumstances presently.*
If you are a casual drinker, if so, how often do you drink?*
Have you attempted suicide in the past 5 years?*

YesNo
If yes, please describe your relationship to these circumstances presently. [Remember, these answers are not necessarily disqualifying, we take each application on a case-by-case basis.]*
Do you have a history of fainting, dizziness or chest pains? If so please state clearly the circumstances.*
Please list any allergies below.*
Please state any other medical conditions or disabilities that we should be aware of that have not been listed above.*
Please describe any other various forms of instability (mental, physical, emotional, financial...) Describe your current relationship with these circumstances and any concerns you may have about the effect these ceremonies may have on it. *
Please describe what kind of post-ceremony support you have (family, friends, therapists, coaches, etc...) Would you like professional support from our facilitators and community? *
I certify that I have read and understood the above and that the information given on this form is accurate. I will not hold any part of Luna Wolf Sanctuary or the people involved responsible for any errors or omissions that I may have made in the submission of this form.*

I agree
Once you hit "Submit," you will see a link to book your Welcome Call, this is required for membership.
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Luna Wolf Sanctuary New Member Intake Form

Once you hit "Submit," you will see a link to book your Welcome Call, this is required for membership.