Refined By Fire
Our Western Cape Date is the 1 - 4 OCT 2026
Dad's Name
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Last Name
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Address
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Mom's Name
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Daughter's Name
First Name
Last Name
Daughter's Age
Dad’s or Daughter's Allergies or conditions
Medical Aid
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Additional Detail:Is there anything that you would like to share with us about your child that will help them, their Event Leaders or ourselves? (aspirations, behavioral problems or anything else)
Are You or your Daughter dependent on any medication which we should be aware of?
May we, via email, keep you informed regarding additional HEARTLAND SA experiences and events in the future?
No
Yes
Cost for Dad and daughter team, all inclusive for on-site duration. Snacks, luxury refreshments etc. not included.
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