Welcome.
My name is Dawn Todd and I'll be your guide in the upcoming Conscious  Cannabis Breathwork Circle.  I take my responsibility as your guide very seriously.  My job is to facilitate (or make easier) a shift in how you think and feel about yourself, where you're going and where you've been.  

My job is to also create a safe environment in which you can feel free to go as deep as you'd like to.  We'll be using a blend of cannabis strains specially curated to create a powerful body sensation while at the same time opening you to your own intuition and creativity.  And doing it without the common side effects of racing mind, anxiety or paranoia.

In order for me to serve you  in the best and most integerous way,  I need to understand your past experiences with other medicines as well as have a brief understanding of ways that you may get triggered in a ceremony.

You can find out more about me at https://dawntodd.com/.  You can also reach me on my cell phone at 720-366-0773 if you have any questions. I'm honored to serve in this good way.

The PayPal link is provided at the bottom of this form.  $33 includes a private integration call after the event. Your registration is not complete until I personally connect with you,  and this intake and the PayPal  transaction is complete.

Blessings,

Dawn
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Please answer the following questions to the best of your ability. There are no right or wrong answers and all your replies are confidential.
Have you experienced mind expanding journeys before? *
If you've done journey work in the past,  what medicine   have you sat with? Please describe what you took and  the approximate amount.  Please provide any details that might help to get a clear picture of what your experience has been. *
If you said yes to the above questions, how did your journey impact your day to day life? *
Do you experience any of the following? *
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Do you have any current or past psychological or psychiatric conditions? Please describe. *
Have you experienced abuse: physical, mental, emotional, sexual?  Check in with your body, if you are comfortable, you may describe further  detail so we can better understand and serve you.   *
Have you had any adverse reactions to alcohol, drugs, or any mind-altering substances? Please describe in detail what was taken and what happened.   *
Are you sensitive or do you generally have a high tolerance to substances?  Have you had to take more or less of a substance than usual to experience an effect? *
Do you have any medical conditions? If so, are you currently in the care  of a health care professional? Please describe the conditions and current  treatment.   *
Do you have a heart condition or high or low blood pressure? *
Please list any medications you are taking,  the purpose of the medication and how long you've taken it. It is essential that we know ALL prescription and  over the counter meds.  If none,  please indicate that. *
Engaging in this work has the potential to lead profound shifts in your life  and it is important to have an aftercare plan & knowledge of resources in  place before hand in order to support your transformation. Having support will help you get the most out of your experience and create lasting  change.  Please  list a friend, loved one, counselor or other trusted person(s) that you might speak with about this work.   *
What practices do you feel will be most beneficial in helping you to integrate this experience into your life? (ie. yoga, mantra, reading literature,  speaking with trusted persons, art, bodywork, journaling, time in nature,  etc)   *
Your safety is a priority, and we do our best to provide safe container, yet  there are risks associated with this work. Therefore, it is helpful to have  contact information for a trusted person should you need assistance get ting home, or if an emergency situation arises.  In the event of an emergency who should we contact?  Please provide name, phone number and relationship of your emergency contact person. *
Please sign and date this form by typing your name below with the date.   *
WAIVER AND RELEASE Please check each box that you agree with. *
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If we haven't had a chance to talk or meet by phone, you can get on my schedule here.
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