Intensive Skills Program Online Application Form

Thanks for your interst in our program!

Please take your time, read each question carefully and consider your answers.
Be sure to fill out the form completely, as incomplete applications will be rejected.

To be considered for the upcoming sessions your application must be received by the deadline given in the program description.
We will e-mail you to let you know that your application has been received.

We look forward to getting to know you better!

Name:
Address:
City:
State/Province:
Zip/Postal Code:
Phone:
Alt. Phone:
E-mail:
Date of Birth:

For which program are you applying?
What is the highest level of education you have completed?
Are you currently attending school?	Yes No
If YES, do you attend full- or part-time?	Full-time Part-time
Do you currently carry personal health insurance?	Yes No
What, if any, previous training or classes have you had in Primitive/Wilderness skills or Survival?
What aspects of Primitive living, Primitive skills, Wilderness Awareness and Survival most interest you?
Which skills, if any, do you currently feel are your strongest?
Why do you want to participate in this program? What makes you a good candidate, and what do you most want to take away with you at the end of your time?
Is there anything else we should know?

Release Waiver

By checking this box I certify that my answers are, to the best of my knowledge, true and complete. I understand that all reasonable precautions will be taken to ensure my safety at all times, but that there are inherent risks associated with the material being taught and agree to assume all risks and hazards incidental to participation in the Practical Primitive Intensive Skills Studies Program, and do hereby waive, release, absolve, indemnify, and agree to hold harmless Practical Primitive LLC and its employees, agents, and volunteers for any claim rising out of injury to self or others. I give Practical Primitive permission to use photographs and/or video of myself for promotional purposes, including advertising. I understand and agree that if I am selected for the Practical Primitive Intensive Skills Studies Program I will submit my non-refundable deposit within five days of acceptance or I may lose my place, and that the balance of tuition is due on or before the first day of the program.

I agree to the terms as outlined above and check this box in lieu of my signature.

Be sure you have completed the entire application before clicking the Submit button!
Incomplete applications will be rejected.

All applications must be RECEIVED by midnight of the deadline date listed in the program details
in order to be considered for the upcoming sessions.