Student Enrollment Data Form

Enrollment Data Form

Please use the following registration Student Data Form by copying the following into an email, filling it out completely, and sending to registrar@shamanism101.com 

After sending this information form to registration, you are ready to enroll by  taking care of tuition.

Important:

Registration cannot admit you to a course untll they receive both your completed Student Data form and your payment.

All material submitted is confidential and private. For complete Privacy Notice click here. Also note course prerequisites: Level 2 requires certification in Level 1, and Level 3 requires certification of both Level 1 and Level 2.


Please complete all sections below. Provide some detail regarding previous training, experiences and goals. 


(1) Full Name: (as you would want it on a completion certificate) 


(2) Email:


(3) Verify Email:


(4) Name that your tuition payment is coming in as: (this is crucial: many paypal or credit card payments come in under names other than that of the student. We need to know the name the payment comes in as so we can mark your tuition as being paid.)


(5) City and Country:


(6) What personal characteristics encourage your shamanic studies?:


(7) What shamanic training or experiences have you had?: 


(8) Use of Quotes: indicate yes we can use, or no we cannot use (for further information see * under 'The Legal Stuff' section below) :


(9) Age: (Must be over age 18, or have parent send to Shamanism 101 an agreement for their minor to take this training.)


(10) Support Newsletter: Please sign up for the student support newsletter.


(11) Terms of Responsibility and Liability: indicate by writing 'I agree' or 'I do not agree' to the terms below. These are matters of ethics, personal safety, and personal responsibility. These are non-negotiable matters and your consent and agreement is required for admission to Shamanism 101 training. Go to the bottom of this page to ** to read the Terms of Responsibility and Liability).

Do you agree or disagree to these terms: (yes or no)


(12) If you are applying for Level 2 or Level 3, and If you have been training with a specific instructor and wish to continue with him or her, include their name here:


(13) You are invited to add any comments to let us know more about you and your goals.  


You are also invited to look at our Privacy Notice, again under 'The Legal Stuff' below, at ***.


Great. Registration looks forward to introducing you to your teacher as soon as they get both this Registration Data Form and notice of your tuition payment, which also serves as your enrollment. Make sure you read the notices below on use of quotes, terms of responsibility and liability, and the privacy note.

Just copy and paste the Student Data Form (all of the above) into your email, fill it out completely in your email, and send to:

registrar@shamanism101.com

The registrar will need the above data sheet in order to enroll you in your course, connect you with your instructor, and get you started. Head over to pay tuition now, if you have not already done so


Please Note!

We want to start you just as badly as you want to get started!

Registration cannot connect you with your teacher until they receive both your Student Data Form and notice of tuition payment (which they will receive from PayPal or the Bank.)


Wow... You did it! Welcome to Shamanism 101 !!!!!

The Legal Stuff

* Use of Quotes

Often, students report astounding things during their shamanic studies with us. By indicating your agreement that we can use quotes from your work, this indicates your consent for Shamanism 101's use of anonymous quotes in books, articles, public awareness materials and publications including on the internet. All quoted material that could reasonably identify its source will be removed or altered to preserve confidentiality unless the author gives explicit written permission for their identification, such as in the publication of a photo, letter, etc. Agreement or disagreement to use quotes does not at all alter your ability to take courses, nor does it affect in any way your passage through the course and ultimate certification. It is simply helpful data that can help others, as well, understand shamanism and its application.

** Terms of Responsibility and Liability (required)

The Terms of Responsibility and Liability as a student in Shamanism 101 must be agreed to in order to take courses. These are matters of safety, ethics, and personal responsibility: things about which there is no justification for compromise. These terms are as follows:

 I (the student of Shamanism 101) promise to not do shamanic work that involves any degree of change of consciousness while in any situation for which common-sense or law would suggest or require that I have my full attention. This would include such activities as driving a vehicle or operating any kind of hazardous machinery, or otherwise placing myself in a potentially dangerous position, such as when climbing a tree, standing or sitting on a rock ledge, being near a roadway, etc. I am taking shamanic training recognizing that such work can destabilize my self identity and my relationship with the world around me, and that this can be very discomforting. I realize I have the authority to do or not do any of the exercises offered in any of the three levels of training, and that this will not jeopardize my passing the courses. I do not hold Dr. Steve Serr, Shamanism 101, or anyone related to this course series (such as teachers, mentors and staff) responsible for anything that happens to me that is in any way related to anything I am being taught, and in any way a consequence of my undertaking this training. By taking part in this training I do not and will not ever hold Dr. Steve Serr, Shamanism 101, or anyone related to this person or this training program liable for anything I ever believe might be damaging to me in any way. Instead, I recognize and completely accept my own authority to learn, participate in, and derive and accept the consequences of this training. By agreeing to this I will have asked for answers from Shamanism 101, LLC to any questions, uncertainties or discomfort I have about this training before I have begun, and that I will continue to ask my teachers and mentors at Shamanism 101, LLC as soon as any discomfort or uncertainty comes up regarding how I feel impacted by this education and training if there is even the barest hint of uncertainty or discomfort.

*** Privacy Notice:

Shamanism 101 completely understands the need for privacy and confidentiality and assures you of this. This privacy notice discloses the privacy practices for http://www.shamanism-101.com and http://www.shamanism101.com .  This privacy notice applies solely to information collected by this web site. 

You have a right to know the following: 

What personally identifiable information is collected from you through the web site, how it is used and with whom it may be shared. 

What choices are available to you regarding the use of your data. 

The security procedures in place to protect the misuse of your information. 

How you can correct any inaccuracies in the information. 

When you submit information via this website form, your information is protected both online and offline. The Shamanism 101 staff takes standard business precautions to protect your information, meaning that reasonable precautions are made so that it is not available to others. 

Information collected on this form is viewed solely by Shamanism 101 instructors and staff and is used strictly to enable feedback to students who submit course materials and who are looking for feedback on these materials. We are the sole owners of the information collected on this site. We only have access to/collect information that you voluntarily give us via email, enrollment form, or other direct contact from you.  We will not sell or rent this information to anyone. 

If you decide not enroll you can ask Shamanism 101 to delete and destroy your enrollment application, by emailing drserr@shamanism-101 and making this request, and your request will be promptly completed. 

Otherwise this data remains the property of Shamanism 101 in order to maintain complete student records of persons who enroll. We will use your information to respond to you, regarding the reason you contacted us.  We will not share your information with any third party outside of our organization, other than as necessary to fulfill a specific request limited to what you ask that you give to us in writing, e.g. to connect you to a fellow student. Wherever we collect personal information, such as you name, address, etc. which you voluntarily provide on the enrollment form, that information is restricted to Dr. Serr, teaching assistants or other employees and used solely for the purposes of contacting you and facilitating your coursework at Shamanism 101 or responding to any other need that you specifically request in writing. Only employees who need the information to perform a specific job (for example, billing or customer service) are granted access to personally identifiable information. The computers/servers in which we store personally identifiable information that you provide to us to receive our periodic support newsletter are kept in a secure environment at constantcontact.com. Course enrollment information removed from online as soon as it is received and filed securely at the Shamanism 101 office. 

Unless you ask us not to, we may contact you via email in the future to tell you about training events, courses or certifications, or changes to this privacy policy. 

Your Access to and Control Over Information: 

We contact you through personal email in response to yours, or periodically through the Shamanism 101 Practitioner Newsletter that is managed by Constant Contact. You may opt out of any future personal contacts from us at any time by contacting us via the email address given on our website and letting us know that, and if you are subscribing to the Practitioner Newsletter, you may opt out of that by selecting the 'opt out' link that is always included at the bottom of every newsletter. 

See what data we have about you, if any. 

Change/correct any data we have about you. 

Those who do not become students can have us delete any data we have about you. 

Express any concern you have about our use of your data. 

Your data and its confidentiality is important to us. If you feel in any way that we are not abiding by this privacy policy, you should contact us immediately via email at answers@shamanism101.com