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"First Name" is a required field.
"Last Name" is a required field.
"Email" is a required field.
"Phone" is a required field.
"Mailing Address" is a required field.
"City, State, Zip Code" is a required field.
"Country of Residence" is a required field.
"Emergency Contact" is a required field.
"What country were you born in?" is a required field.
"Please list any/all languages you speak and fluency in each" is a required field.
"What is your current age?" is a required field.
"Gender" is a required field.
"Social Media Profiles or Website" is a required field.
"Which of our training retreats are you applying for?" is a required field.
"Or you currently on - or have you ever been on the Sex Offenders Register?" is a required field.
"Do you have a current passport?" is a required field.
"Do you have any medical training?" is a required field.
"Do you have a current certification in First Aid / CPR?" is a required field.
"Do you have any training as psychotherapist - or a degree in psychology?" is a required field.
"Describe your physical health" is a required field.
"Do you practice Reiki, Qigong, mediation, chakra therapy, massage, yoga or any other modalities of energy medicine? Do you have certifications in any of these modalities?" is a required field.
"Pregnant or think that might be pregnant?" is a required field.
"Breastfeeding a child under 1 years old?" is a required field.
"Any serious heart conditions including pacemaker, defibrillator, valve disease, blood clots, bypass surgery and/or enlarged heart?" is a required field.
"High or low blood pressure? " is a required field.
"A stroke, aneurysm or bleeding in the brain?" is a required field.
"Addison’s disease?" is a required field.
"Ehlers-Danlos syndrome?" is a required field.
"Organ transplant surgery?" is a required field.
"Epilepsy (or prone to seizures)?" is a required field.
"Ulcers?" is a required field.
"Recent operations or fractures?" is a required field.
"Anxiety/Psychotic disorder?" is a required field.
"Any dysfunction of the nervous system?" is a required field.
"Cancer?" is a required field.
"Inflammation?" is a required field.
"Hernia?" is a required field.
"Taking medication for low blood pressure?" is a required field.
"Undergoing/undergone chemotherapy or radiotherapy? " is a required field.
"Taking any immune-suppressants for organ transplant?" is a required field.
"Undiagnosed pain?" is a required field.
"Any type of infection or disease?" is a required field.
"Will you be at the end of a fast or fasting during your course?" is a required field.
"Have you ever been hospitalized?" is a required field.
"Do you currently have a serious mental illness or have you ever been treated for a serious mental illness?" is a required field.
"Are you currently or have you ever received therapy, attended a support group, and/or worked with a counselor, psychiatrist, psychologist or psychotherapist?" is a required field.
"Is there anyone in your family with a history of psychiatric disorders?" is a required field.
"Have you experienced traumas in your life? This includes traumatic events as well as ongoing traumatic experiences." is a required field.
"Do you drink alcohol?" is a required field.
"Do you smoke?" is a required field.
"Do you use any "illegal" substances?" is a required field.
"Have you used Bufo Alvarius in the last six (6) weeks?" is a required field.
"Are you taking ANY western medical prescriptions, over-the-counter, or alternative, homeopathic medications or taking herbal supplements? If so, please list below and explain" is a required field.
"How many times have you received Kambo and when?" is a required field.
"What calls you to serving Kambo?" is a required field.
"Why do you believe you'll be a good Kambo practitioner?" is a required field.
"What have you healed with the help of Kambo?" is a required field.
"What draws you to this training more than others?" is a required field.
"Have you ever served Kambo?" is a required field.
"Would you be interested in joining Tribal Teachings for a post-training plant dieta? (Separate costs would apply and additional deposits required)" is a required field.
"Explain in Details" is a required field.
"Please include any additional comments or questions you have about the training:" is a required field.
"Digital Signature" is a required field.
"Application Agreement" is a required field.
"Refund / Cancellation Policy" is a required field.
"Please answer yes or no to the following statement: I hereby give Tribal Teachings permission to use my photographic likeness in images or videos taken during this retreat on their website, in print material or other broadcast media for the use in promotion of their projects and programs." is a required field.
"I have read and agree to the Terms and Conditions" is a required field.
"Participant's Full Name/Digital Signature" is a required field.
"Enter your full name, first and last" is a required field.
"Date" is a required field.