The Visionaries Public Programme Registration
It's great you're interested in The Visionaries Programme. To take part in the programme we need you to complete this registration form as it will help us to get to know you and find out a bit about why you want to take part in the programme. All the information filled out will remain completely private and confidential. This really isn't a test and there are no right or wrong answers, we use it simply as a way to get to know you and your ambitions for joining the programme a little better before fully signing up.

Please complete all questions on this form fully and honestly. If you want help filling in this form just ask your teacher or email us at hello@thevisionaries.org.uk. If you wish to advise our staff of any confidential issues which may affect you during your course, please include this information below.
Email address *
First Name(s) *
Last Name *
School *
Year group *
What are you passionate about? How do you choose to spend your time outside of school? *
What would you like to be learning about life that you are not being taught in school? *
What skills do want to develop before leaving school that will help you step out into the world feeling confident you can achieve your dreams? *
What does your wellbeing mean to you? Do you feel it is important? If so why? *
What is your relationship to nature and the planet? *
Who do you look to when you need some support in life? Do you have a trusted adult who helps to guide and mentor you? *
How confident do you feel working with strong emotions? *
How comfortable do you feel about the following: *
1 = Not at all comfortable, 5 = Very comfortable
1 Not comfortable at all
2
3
4
5 Very comfortable
Talking about your feelings
Talking about your feelings in a group
Being without your phone for a long period of time
Meeting new people and making new connections
Trying new things and being out of your comfort zone
Working as part of a team
What would you like to get from taking part in The Visionaries programme? *
Name *
Email *
Mobile Phone Number: *
Name of Next of Kin and Telephone Number: *
Your Organization (if any) *
Where Did You Hear About Us? *
How are you planning to arrive and depart to the programme? Please provide train, bus or plane details, or if not known, please email max@thevisionaries.org.uk upon booking transport. *
Dietary restrictions *
Do you suffer from any of the following conditions? *
Required
Do you suffer from epilepsy? *
Do you suffer from any other condition requiring that we should be aware of including previous injuries, medical treatment and medication? *
Are you allergic or sensitive to any medication (e.g. Penicillin), insect bites or food? *
Are you taking any form of medication on a regular basis? (If so please ensure that you have adequate supplies of medication for your entire visit) *
To the best of your knowledge, have you been in contact with any contagious or infectious diseases, or suffered any recent condition that may become infectious or contagious? *
Please provide any additional appropriate information concerning your health: *
In order to participate in a The Visionaries Programme it's essential that you have read through and agreed with our Terms and Conditions that you can view on our website. Please take some time to read through it.
By clicking 'Yes' below you confirm that you have read through and understood the Terms and Conditions agreement between yourself and Wayfinders 2018 CIC t/a The Visionaries CIC. *
Required
To confirm your place we ask for payment of the full amount of £595. Please use your last name as your reference when paying into the bank account below and drop us a quick note to hello@thevisionaries.org.uk when you have made the transfer. Bank details - Name of account: Wayfinders 2018 Sort code: 08-92-29 Account Number: 65865332 Company Details: Wayfinders 2018 T/A The Visionaries CIC UK Company number: 11748205 The Visionaries CIC is not VAT registered. Thank you.
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