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Syracuse Herbal Study Group Apothecary Donation Form
First name
*
Last name
*
Phone
*
Email
*
Address
*
I am dropping off herbs that:
*
were gathered or prepared by me or someone else I know
were purchased and prepared by a company
Please list all items being donated and their contents, including herb names and other ingredients, along with the amount of each being donated.
*
Donation Safety Checklist. I confirm that:
*
All items handmade or gathered were collected at least 10 feet away from buildings, roadsides or pesticides
All items were grown and/or wildcrafted sustainably, and that no at risk or endangered plants were wild harvested
All purchased items have a visible expiration date
All handmade or gathered items have a "date collected" or "date made" on them
To the best of my knowledge, all items donated were made and prepared safely, and none of my donations were home prepared or gathered by individuals unknown or untrusted by me
None of the items donated were gathered from protected land
I have reviewed the SHSG Apothecary Statement on Safety & Sustainability and I agree that my donation meets all of these standards
Signature
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