Harriet's Apothecary Registration
HARRIET’S APOTHECARY HEALING VILLAGE: WINTER EDITION 2018

Harriet’s Apothecary is an intergenerational healing village led by the brilliance and wisdom of Black Cis Women, Queer and Trans healers, artists, health professionals, magicians, activists and ancestors. We are committed to co-creating accessible, affordable, liberatory, all-body loving, all-gender honoring, community healing spaces that recognize, inspire, and deepen the healing genius of people who identify as Black, Indigenous and People of color and the allies that love us.

www.harrietsapothecary.com

We are so grateful you are coming to take care of yourself and in turn taking care of the communities you are a part of. We want to intentionally and appropriately prepare for your arrival and learn more about who will be in the space. Please take a moment to fill out this registration form to tell us more about who you are and what your needs are. See you soon. WE CAN'T WAIT TO WELCOME YOU IN THE SPACE!!!!!

For details visit our website: www.harrietsapothecary.com

▽ DATE: Saturday, December 16 and Sunday, December 17

▽LOCATION▽:
MINKA Brooklyn, 1120 Washington Avenue, Brooklyn NY

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We strive to ensure that Harriet’s Apothecary is accessible and welcoming to our community. If you have access needs and/or need support in attending Harriet’s Apothecary in the fullness of your being, please email harrietsapothecary@gmail.com . Also feel free to indicate your needs in the registration form.

DIRECTIONS
Take the Q, B train to Prospect Park. Head east on Lefferts Avenue toward Washington Ave. Turn left onto Washington Avenue.

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This building is a wheelchair accessible. There are elevators in the building to go from floor to floor.


Please be scent/fragrance-free to the extent that you are able to, so that beloved community members with chemical sensitivities can attend Harriet’s Apothecary. If you need support being scent/fragrence-free feel free to contact us at harrietsapothecary@gmail.com

We are working on providing free childcare. Please register for Harriet’s Apothecary Winter Edition by December 8 if you need childcare. Also provide how many children will be attending with you and if they have access needs.

Please support us in making Harriet’s Apothecary more accessible to more people each season. If you have feedback, questions, or suggestions, or want to volunteer or help organize around access, please email harrietsapothecary@gmail.com

We will have designated scent-safer spaces at Harriet’s Apothecary.

Suggested entry donation $5-$20. No one will be turned away for lack of funds.

First Name *
Please tell us the name you would like us to use when we connect with you
Your answer
Last Name *
Your answer
Personal gender pronoun *
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Year of Birth *
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Mailing Address
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Email address *
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City
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Zip code
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Organizational affiliation
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Do you have any accessibility needs? We will do our best to meet them
Do you have chemical sensitives to scents, fragrances or odors? If so, please share with us
Your answer
What Ethnic/Racial backgrounds do you identify with? *
Your answer
How do you identify your gender (please select ALL that apply) *
Required
If none of the above accurately describes how you identify, please elaborate
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Do you have childcare needs?
If you desire childcare, please share how many children will be coming with you, their age and if they have access needs
Your answer
What are you most excited about attending this space? *
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Please share any concerns you have about being a part of this space
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How did you hear about this event? *
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Additional comments
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