Plantcestral reMembrance for SWANA Healing WINTER 2019
Please fill out this registration form so that I can better coordinate our class. It is due December 27th if you would like to participate. Please send payment to PayPal.me/RiverRose as soon as you are able to and no later than January 6th.

Please note that you're completing this form is a COMMITMENT to participating in this class and completing subsequent payment. I usually require deposit at the same time as this application form to save your spot and send off the herbal packages, but due to holiday season, I am extending deposit until January 6th. I will be sending your herbal packages as soon as you send this, and I cannot undo that nor its cost so please honor this commitment before you send this form.

Thank you!

Email address *
Name: *
Your answer
Phone Number: *
Please also note if you are responsive and okay with receiving text message communication or whatsapp if you are not based in the US.
Your answer
Gender pronoun(s)/how you like to be addressed, including if you have a nickname you prefer or anything else you'd like to note here.
Your answer
What city/state/country do you currently live in? Please share the exact mailing address you'd like your herbal package to be sent to. *
Your answer
Where do your ancestors come from? What specific part(s) of the SWANA region do your SWANA ancestors come from? *
If you are mixed race, please feel welcome to share all of the different regions/countries your ancestors come from. This info will help me better honor you and your ancestors as I prepare for our course.
Your answer
What inspires you to join this class? What do you hope to gain from participating? *
Your answer
This class is rooted in experiential knowledge building and the cultivation of personal relationships with our plantcestors. We hold the sharing in a confidential and sacred container that is very small and intimate. The possibilities for learning and healing in this class are FULLY dependent on your own active participation and presence with the material and group. Please note that working with plantcestors in this deeper personal way has the potential to open gateways to feelings, experiences, consciousness, and understandings of ourselves that we may have not had or been able to face before. The plantcestors require us to meet them halfway in our own healing processes as they move through us, reflect, and teach us. The facilitator and container is designed to support and witness participants through these changes if and when they arise, but participants are also advised to take care of themselves independently and be prepared for whatever might arise by ensuring adequate support independently (alongside the group support). Do you commit to meeting this process to the best of your ability and capacity by being present for yourself, the plantcestors, and our group time together? *
If you have any questions, concerns, or clarifications about this, please feel free to ask or indicate via email or in the "other" category. It is nothing to be afraid of, but just important to be honest and direct about so you are not surprised if things arise. The structure of the class and the plantcestors themselves are designed to hold this well and as gently as possible, but each person and plant has its own mysteries to offer to the process and so...
Is there any 1 particular SWANA plantcestor you would love to learn more about? Please name it, if so.
Your answer
What is your personality typically like in group/class settings? *
Are you introverted? Do you ask a lot of questions? Are you responsive and engaged in proactive feedback with material and students? Are you timid? Is sharing difficult/easy/desirable/anxiety producing for you? Etc... Knowing this will help me match group personalities in a way that can be more balanced and harmonious for our group flow. All of the above are perfectly okay.
Your answer
Because this is an online class, communication is extremely important to help things flow for the whole group and for me as a faciliator. We often have to follow up on things over email. Do you commit to responding within 24-36 hours to class related emails that require a response? *
Usually these responses are simple and can be completed within 10 minutes. Sometimes we have more detailed correspondence but we will discuss and decide on those things as a group based on the activites going on.
Your answer
Are you comfortable with working with alcohol based herbal extracts at times during this class? *
This would involve you taking 1-5 drops of herb infused alcohol tinctures a couple times a day or through our class meetings. If you are not comfortable with this, fear not. I have alternative ideas for you that will not affect your participation.
Your answer
Do you have any known sensitivities or allergies to any specific herbs or substances? Please list them here if so. Please also list here if you are sensitive to scents. (Many of the plants we work with are naturally aromatic. We sometimes work with essential oils too. I can leave these out of your package if you prefer). *
Your answer
Do you have any health conditions? Please list them. Please also list any prescription medications you take for each one. Please also note if you are pregnant or possibly pregnant. *
This is confidential information. It is necessary to help me work towards your safety when delegating our herbal material. If you are not comfortable sharing details, you can just answer a simple "yes" below and we can discuss a general strategy for approaching the material in a way that is safe for you despite possible contra-indications, etc.
Your answer
Do you commit to completing payment & active participation for the full course of our series? *
This is a non-refundable commitment. Please understand that the time, energy and value of the herbal package alone is not something I can undo or reverse and that there are limited spaces in this class. If someone cancels midway, I cannot replace their spot. That being said, your active participation and presence is expected in each session and greatly impacts the group experience (I understand that sometimes we are sick, have emergencies, etc. I am asking for folks full intention to try to be present for our meetings and the work in between to honor the energy of the group and nature of the offerings). Please also note here if a payment plan is needed- I will follow up with you about details soon after.
Your answer
Do you have a 9-5 job Mon-Fri? *
I am trying to create a time that works for people in multiple time zones so the next couple questions are about your schedule. Please be as flexible as possible and share any details you think might be helpful.
Are you open to meeting on weekends? (Or on one particular part of the weekend? Please specify in "other". *
Do you have any days or times of day in general that absolutely don't work for you? Do you have any that are preferences? Please let me know as clearly as possible. *
Your answer
How/ from whom did you learn about this class?
Your answer
Do you have any other questions, comments or concerns to share with me? Please do so here.
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