Your Wild & Precious LifeApplication Form Name * First Name Last Name Email * Address and phone number * Name, telephone number and relationship of someone to be contacted should the need arise: * Please let me know in brief what has drawn you to this course? * Have you received psychiatric or psychological treatment before? * Do you have any mental or physical issues, or have you had any recent life changing experiences or past traumatic events that would be useful for me to know about? * Do you have any physical difficulties that make sitting difficult? * Is there anything else you think would be useful for me to know? * I understand the possible challenges that a course such as this may generate and am confident I have the necessary support to be a part of it * Yes, I understand Date MM DD YYYY Thank you for taking the time to complete this form!I will be in touch with you in the next 24 hours to let you know if your application has been accepted. With kind wishes,Claire
