Course Application - Louise Carron Harris

Please fill out the questionnaire below with as many details as possible. Please note that all of your answers are completely confidential and will NOT be shared with anyone else.

Full name*
Age*
Gender*
- Male
- Female
- Other
Phone number*
Email address*
Town/Country of residence*
Website, Facebook, Twitter, Instagram etc
Emergency contact*
What is your current profession or main occupation?*
Why do you wish to participate in this programme and what are your aims in doing so?*
Have you ever done anything similar or comparable?*
Are you a member of the my ‘Awakening The Medicine People’ membership group?*
- Yes
- No
Have you attended any of my other courses?*
- Yes
- No
If you were to imagine yourself and your circumstances in 10 years time what would you see?*
How would you describe your personality- strengths, limitations, potentials?*
What are your interests, leisure pursuits, ways of relaxing?*
Do you have any physical or mental health issues?*
Do you take any kind of prescribed medicines?*
Do you take any recreational drugs?*
Do you have any practical experience of plant medicines? If so, when, how often, and for what reason?*
Do you have any kind of daily practice?*
Do you follow any kind of spiritual ‘way’ or have any specific spiritual or religious beliefs?*
Anything else you would like to add?