Name:

Birth date:

Address:

Phone #:

Cell phone:

Person to contact in case of an emergency:

Address:

Phone #:

E-mail address:

Health Insurance:

yes

no

Health Insurance Provider:

#:

Are you familiar with living in the tropics?       bugs?          weather?

Do you have any food allergies?

Do you plan to rent/buy a car while here?

Arrival date:

Departure date:

(Dates may not be changed once they have been settled upon.)

How did you hear about Pat’s farm?

Your experience:

Please take time to look at the http://www.biodynamics.com website so that you are familiar with Biodynamics as a farming philosophy.

Do you have any questions about Biodynamics?

Do you have any farm experience? Or gardening on a large scale?

What do you hope to learn while here at the farm?

Anything else you’d like to tell us about yourself?