Your Details |
| First Name*: | | Surname*: | |
| Sex: | |
Date Of Birth:
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| Nationality: | |
| Passport no: | | Expiry Date: |
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| What is your usual occupation? | |
| What qualifications do you hold? | |
Contact Details |
| Address*: (where you would like us to send all the information to) |
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| Post code*: | | City*: | |
| State/County (if applicable): | | Country*: | |
| Phone(work): | | (home): | |
| May we call you at work? | |
| Mobile: | |
| E-mail Address*: | |
| Please advise us if any of these details change prior to your departure |
Emergency Contact |
| Name: | |
| Relationship to you: | |
| Address: (if different from applicant's) |
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| Post code: | | City: | |
| Country: | |
| Phone(work): | | (home): | |
| Mobile: | |
| E-mail Address: | |
Your Travel Program |
| Duration of stay at the project: | |
| Start date at the project: |
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| (Please note that the project always starts on a Friday) |
| Is this approx or the actual date you would like to start the project? | |
| Will you be doing any independent travel before or after the project? | |
| If so, please give us some brief details of your arrangements: |
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| Do you intend to do this project with another applicant? | |
| If so, could you please provide us with their name: | |
Would you like us to help arrange your international and internal flights?
(We are unable to book them for you but we can help to find you the best deal possible) | |
Health and Fitness |
| Do you have a physical disability? | |
| If so, which? | |
| When disabled, are you self-sufficient or do you need assistance with one or several daily chores e.g. eating, dressing yourself etc.? If you need assistance, please note that you will have to bring along your own carer, standard rates apply. | |
| If you need assistence, could you please inform us on what kind of assistance you need in order to inform the project leaders about the severity of your handicap |
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| Whether able-bodies or disabled, do you have any medical condition or anything that we should be aware of medically? | |
| If so, which: | |
| Are you on any prescription drugs or medication? | |
| If so, which: | |
| Do you have any dietary requirements (e.g. vegetarian) / allergies? | |
| If so, which: | |
| How would you describe your fitness? |
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| Is there anything else Kameleon and the projectleaders of the Wildlife Orphanage should know with regards to your health and/or handicap? | |
| If so, what: | |
A bit more about you |
| Please introduce yourself to us by telling us a bit about your interests, previous travel, any previous experiences with animals, language skills, first aid and any other relevant information or qualifications which may be useful |
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| Please give your reasons for applying to join this project. What do you hope to gain from the experience? |
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| What are you currently doing? Working, studying etc. |
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| Please tell us if you have any queries or concerns about the Wildlife Orphanage, so that we can provide you with further relevant information if necessary. |
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| And finally, please can you tell us where you heard about Kameleon? | |
| To the best of my knowledge, the information given on this form is correct. I believe I am medically fit enough to travel to and work in Southern Africa. | |
| On application I hereby agree to the terms and conditions of Kameleon Adventures (available to view on our website and by hardcopy on request) | |
| After we’ve confirmed your booking and you’ve paid the deposit, we will send you Kameleon’s Pre Departure Pack. In order to save paper and ink and thus the environment and to keep the program costs as low as possible, we prefer to burn the information booklet of this Pack on cd-rom. This way, you can also choose for yourself whether you want to print and bring along certain pages instead of having to carry the whole bunch! But of course your wishes are the most important to us. Therefore, please fill out your preference: | |
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