Rewilding for Resilience

Course Application Form

Participants interested in the Rewilding for Resilience course are required to complete an application form so that we can ensure that the course is a good fit for you and tailor content / activities to participant interests where possible. Your application also helps us to understand your intentions and medical background so we can know how best to support you during our time together.

Your personal information is stored in accordance with the POPI Act and never shared with a third party, unless we need to advise course partners (e.g. caterers, nature guides) medical concerns, dietary preferences or allergens that may compromise your safety. We ask our partners to hold that information in utmost confidence.

    First Name

    Last Name

    Date of Birth

    Email

    Phone Number

    How did you hear about this course?

    What motivates you to join Rewilding for Resilience?

    What do you hope to gain by participating in this course?

    What passions, interests, expertise or talents do you bring?

    Some physical activities carried out during this course (e.g. coastal walking, swimming) may be strenuous, hazardous or carry risk of injury. Such hazards may be increased if you have certain physical conditions. The purpose of this brief medical questionnaire is to make us aware of these conditions and to ascertain whether they require extra supervision, follow-up or medical advice.

    Do you have any specific dietary preferences and/or acute food intolerances or allergies?
    YESNO
    If YES, please specify and distinguish between 1) dietary preferences 2) medical allergies (incl. severe food intolerances):

    Do you have any medical condition/s that may be made worse by physical exertion (e.g. heart disease, asthma and some lung complaints)?
    YESNO
    If YES, please specify:

    Do you have any medical condition/s that can result in the loss of consciousness? (e.g. including forms of epilepsy, diabetic conditions)
    YESNO
    If YES, please specify:

    Do you have any respiratory condition such as asthma that can be brought on by exposure to cold water, pollen or sand/dust?
    YESNO
    If YES, please specify:

    Do you have any other physical and/or emotional conditions, illness, allergies, injuries or personal needs that you feel are important for the facilitators to know about, or current life circumstances (incl. pregnancy) that might prevent you from fully participating in the program?
    YESNO
    If YES, please specify, and how you are supported in working with this:

    I am aware this program may involve physically and emotionally strenuous activities and may increase the health and safety risks to me if I answered ‘YES’ to any of the above.

    Do you feel willing and able to fully commit to the program if admitted?
    If not, please describe what is in the way of that.

    Rewilding for Resilience commences TBC (exact location to be provided later) and finishes on TBC at 10:00.

    This is a residential-style course designed to support an immersive group learning experience. We strongly encourage participants to be present and engaged for the entire time (extenuating circumstances understood).
    Can you foresee any obstacles in attending uninterrupted for the duration of the course?
    YESNO
    If YES, please specify:

    Please share any other things that you think are important for us to know at this time. This may also include - but is not limited to - ways in which you identify that you would like us to know about ahead of your participation. (e.g. preferred pronouns, gender identity, orientation, nationality, race/ethnicity, culture, religious affiliation, or any other identities which are important to you and are important for us to be aware of and sensitive to):

    I confirm that I have answered the above questions honestly and accurately.

    Thank you for your responses!

    Once submitted, you will receive an email acknowledging your application and providing banking details so you can make for your 50% deposit to secure your place in the programme.

    Please be assured that if the course is cancelled, postponed or, upon reviewing your application, we decide that the course is not a suitable fit for you, your deposit will be refunded in full. Hope you can join us!