Application Form: Leopard Warrior Trails: 18th-26th May 2024

Application Form: Leopard Warrior Trails: 18th-26th May 2024
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Your Mobile Number (including country code)*
Who to contact in an Emergency
Emergency Contact Name*
Emergency Contact Number*
Relationship to you*
Intention for coming on this retreat? (Please write a few lines)*
Do you have a Spiritual practice? (Include a brief history of your background & experience)*
Do you have a history of mental or physical illness? (Such as bipolar, schizophrenia, major depression etc. Please give a brief outline)*
What is your current physical and mental state? Please be aware that deep spiritual work can bring up difficult emotions and old wounds. *
Are you able to walk 5km (3miles) in one hour without physical stress?*
Can you walk comfortably with 30 pounds on your back for extended periods? We will be on trail for 3 days and you will need to carry your own food (supplied by us), plus sleeping bag and clothing. *
Are you able to sleep on a sleeping mat under the stars for 3 nights?*
It is a requirement of this retreat that all participants take out comprehensive travel insurance. We require a copy of your medical insurance.*

I agree to having comprehensive travel insurance and will provide a copy of my medical insurance
Do you suffer from any allergies?
Do you have any dietary requirements? We will be in a very remote area with specialized foods hard, but not impossible to source in South Africa.*
Where did you hear about Leopard Warrior Trails?*
Nature is unpredictable. It is vital that all participants adhere to the Health & Safety instructions laid out by Massimo Rebuzzi when they arrive.

*If any participant puts themselves or any member of the retreat at risk then they will be asked to leave at their own expense with no refund.

NB: No part of this retreat can be shared, copied or distributed. John Lockley and Massimo Rebuzzi hold the sole copyright of their respective teaching modules.
I, First Name* Last Name* have read and agreed to all clauses stated in this form. I indemnify John Lockley, Massimo Rebuzzi and Associates from any harm, loss of property or personal injury that may result from me participating on this retreat.
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