APPLICATION FORM CHAMELEON TRAVEL AFRICA

First name

Surname

Sex

Date of birth

Nationality

Passport no.

Expiry date passport

My passport has expired:

CONTACT DETAILS

Address

Postcode

City

State/County (if applicable)

Country

Phone (home)

Mobile phone

Email address

Please inform us as soon as possible if any of these details change prior to your departure!

YOUR TRAVEL PROGRAMME

Start date

Will you be doing any independent travel before or after the project(s)?

If so, please give us some brief details of your arrangements:

Other applicant?

Name other applicant?

Help with flights? (International and domestic flights). We are unable to book them for you but we can help to find you the best deal possible.

Which project(s) would you like to join? And for how long? If you have a preference in order of projects, we will try to organise this for you, however, we cannot guarantee that places will be available in your chosen order.

Preference for certain order: (if Yes, please write the names and duration of projects in the order you would prefer to join them)

Preference certain order?

1st Project select

Duration in weeks

2nd Project select

Duration in weeks

3rd Project select

Duration in weeks

4th Project select

Duration in weeks

In case of 'Other', what is your request?

INTERNSHIP

If you apply for an internship and your participation forms part of your studies, please fill in below questions (otherwise skip this part)

Are you applying for an internship?

What is the name of your school/college/university?

What is the name of your study?

Can you provide us with a short description of your study?

Can you provide us with a description of the requirements of your internship with the project(s) (number of hours, specific skills/experience to gain, etc)

What is the name of your internship mentor at school/college/university?

What is the email address of your mentor?

What is the phone number of your mentor?

Is your internship placement required to be accredited with S-BB (only applicable to Dutch students)?

If so, what is the crebo number of your study?

Do you have any personal specific requests with regards to your internship placement at the project(s)?

HEALTH AND FITNESS

Do you have any medical condition or anything that we should be aware of medically?

If yes, please provide us with more information

Are you on any prescription drugs or medication?

If yes, please provide us with more information

Do you have any dietary requirements (e.g. vegetarian) / allergies?

If yes, please provide us with more information

How would you describe your level of fitness

EMERGENCY CONTACT

Name

Relationship to you

Address (if different from applicant's)

Postcode

City

Country

Mobile phone

Email address

Please inform us as soon as possible if any of these details change prior to your departure!

IF JOINING AFRICAN EQUESTRIAN EXPERIENCE (otherwise just skip this part)

Your height (in cm)

Your weight (in kg)

I am able to groom and tack up

I am able to mount and dismount

I am able to control a horse at a walk

I am able to control a horse at a trot

I am able to control a horse at a canter

I am able to control a horse at a gallop

I am able to stop a horse from any pace

I am able to jump

Do you have experience of riding over rough terrain?

Do you have any medical condition or disability that may affect your ability to ride?

If so, please provide us with brief details

A BIT MORE ABOUT YOU

Please introduce yourself to us by telling us a bit about your interests, previous travel, any previous volunteering experiences, language skills, first aid and any other relevant information or qualifications which may be useful

Please could you tell us more about the reasons for applying to join the project(s). What do you hope to gain from the experience?

What are you currently doing? Working, studying etc.?

Please tell us if you have any queries about the project(s) that you are joining, so that we can provide you with further relevant information if necessary.

And finally, please can you tell us where you heard about Chameleon Travel Africa?

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 Chameleon Travel Africa (available to view on our website and by hardcopy on request)