Natures Resonance

Natures Resonance

A Rite Of Passage Program for Youth
Participant Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityRegion / State / Province

Postal / Zip Code
E-mail*
example@example.com
Mobile Number*
Format: (000) 000-0000.
Name of emergency contact*
Emergency phone no
Please enter a valid phone number.Format: (000) 000-0000.
Name of care person or person who identifies as a elder to you

First NameLast Name
Phone no of your care person or elder
Please enter a valid phone number.Format: (000) 000-0000.
What are you hoping to experience during this program?*
Please share your comfort level in nature*
I feel confident to set up a tent on my own and my bedding including inflatable mattressI don't have any experience but feel confident I can learn with supportI feel completely out of my element camping and will need support
A tentA camp mattressA sleeping bagA backpackNone of the above as I have all of those items
Please share a bit about yourself and any important moments in your life that you believe have influenced and shaped you significantly.
Part of this program includes 2 nights of solo fasting. Please share any concerns or fears you may have about participating in this aspect of the program.
Please share any dietary requirements below
Is there anything else you think would be useful to share, that would help us best support you? Emotional, physical or other such as allergies, and health issues that you may need support with.*
I would like a ride from the airportI have a car but cannot offer others a rideI have a car and can offer others a ride from the cityI need a ride from the city central bus stationOther
If you selected 'other', please share here. Or, if you are driving and have room to offer others a ride, please share where you are driving from.
For our marketing research would you please share how you heard about this program?*
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