Application | Family Herbalist Program 2024

CONTACT INFORMATION

Name: *

Phone: *

Email: *

COURSE QUESTIONS

Why did you choose this school and the Family Herbalist course?

After reading through the topics for the Family Herbalist program, how do you plan to use the information and skills?

What are your long term goals in the field of herbal medicine and healing?

What is your previous experience or training in: (Previous experience is neither required nor expected.)

Healing: (This includes both mainstream and alternative approaches)

Plants: (This includes gardening, botany, landscaping, cooking, etc)

Herbal Medicine: (This includes both formal study and independent study and experience)

Are you able to attend the extra free optional Field Study days?
YesNo

What would you like for me, as the instructor, to know about you to help make this a quality experience for you?

What do you see as the biggest challenge to you successfully completing this program?

Other Comments/Questions: (include any other information that is important)

EMERGENCY AND HEALTH QUESTIONS

Assuming you are accepted into the program, please provide the following health information (all information is confidential):

Emergency Contact Name: *

Emergency Contact Relationship: *

Emergency Contact Phone: *

Allergies: (please be specific - medications, insects, plants, gluten, etc...)

Are you at Risk of anaphylactic shock?
YesNo

If yes, where do you keep the epi-pen?

Do you have any health issue or disabilities that are relevant to the activities of this program (which may include field work that involves some hiking)?