General Membership Intake Form – Willow Dragonstone Community

Name *

First

Last

Magical Name if You Have One *

First

Last

Please select which pronouns you prefer:

Email *

Phone Number

Month/Date/Year of Birth (WDSC will be pulling your astrological chart to look at compatibility with the group.) *

Time of Birth, AM or PM (If you do not know the exact time of your birth, please guesstimate noon or midnight.) *

Location of Birth *

I had a great childhood. *

When bad things happen to me, it is: *

I am usually on time. *

I have considered myself a pagan (see FAQ for Willow's definition of Pagan) for: *

When thinking about your experience and knowledge in paganism, do you consider yourself a *

I have the following allergies. *

The important medical things Leadership in Willow should know about me are: *

The following person is my emergency contact with phone number. *

The Ieadership in Willow should know the following things about me: *