Participant List

Gender: Male

Birth Date: 1996-04-23

Email: cgoen11@gmail.com

Phone: (972) 467-2283

City: Farmersville

State: Texas

How did you discovery Two Birds Church?: Google

Have you attended any Sunday Services, Outreach, or Virtual Services?: Yes. 2 so far.

Emergency Contact Phone: (214) 585-1482

Relationship: Mom

Emergency Contact Phone: (210) 606-8862

Relationship: Wife

Have you ever been hospitalized for mental health reasons?: No

Have you ever had thoughts of harming yourself?: No, never

Have you ever had thoughts of harming others?: No, never

Are you currently in a mental health crisis or acute emotional distress?: No

Have you ever served in the military?: No

Have you done a Ceremony before?: No

Do you have any experience with other plant sacraments?: Na

What is bringing you to ceremony at this specific time in your life?: Na

Please tell us a little about your Intention for Ceremony: My intention for Kambo is to push myself physically and spiritually.

Are you currently using any recreational substances?: No

Have you ever had a traumatic brain injury (TBI), concussion, or significant head injury?: No

Are you currently pregnant?: No

Do you have any food allergies we should be aware of when preparing meals?: No.

Are you currently taking any prescription medications, supplements, or recreational drugs.: No, medications or drugs'

Health Conditions: No.