Three Springs Community
Visitor, Intern, Work Exchange Questionnaire
Please answer these questions and submit them to us thank you!
Your Name:
*
Your Email
*
Your Address:
*
Phone Number:
*
Cell Number:
*
EMERGENCY CONTACT 1:
*
Phone Number:
*
EMERGENCY CONTACT 2:
*
Phone Number:
*
Do you have health insurance:
*
Yes
No
Insurance contact information:
Please describe any allergies or medical needs you have:
*
What is your intended length of stay:
*
Please describe any dietary preferences or needs:
*
How did you find us:
*
Why are you interested in being here:
*
What skills do you bring:
*
What gardening and community experience do you have:
*
We reserve the right to terminate the length of stay of any
visitor, intern or work exchange person.
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