Name * First Name Last Name Email * Phone Number * Date of Birth * Sex * Where do you live? * Emergency Contact * Do you have any medical conditions? * Are you currently taking any medications? If so, please list: * Do you currently suffer from any infectious or contagious disease? Do you have any cardiovascular disease, including heart attacks? * Do you have any allergies? * Do you have any blood pressure condition (high or low blood pressure)? * Are you working with any musculoskeletal issues? i.e. bone breaks, joint pains, arthritis, etc * Do you suffer from Asthma? If so, when is the last time you used an inhaler? * Do you have any diagnosed or undiagnosed mental or cognitive health conditions? Do you use alcohol? If so how much per week? * Do you use any drugs? Cocaine, heroin, synthetic opiates, etc. * Are you actively ingesting a nicotine containing product such as a vape pen or smokeless tobacco? * Are you currently pregnant or breastfeeding? * Have you ever ingested a purgative medicine such as Ayahuasca, Kambo, Tobacco, etc? * Which ceremony dates are you interested in attending? * Thank you! CEREMONY INTAKEBefore sitting in prayer with a strong plant medicine, it’s imperative that we cover some basics to ensure a safe and grounded healing journey. JOIN THE 2025 SPRING TOBACCO APPRENTICESHIP FEBRUARY 10th - MAY 13th Learn more
