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Application Form
For Guest at the Savanna Hermitage. Rather than try to portray yourself in the best light, please answer all questions as accurately as possible. For example, you will not be disqualified if you stream Netflix with a glass of wine. All applicants will receive a confirmation email and contact information.
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Email
*
Your email
Name
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Your answer
Age
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Your answer
Current physical address- street, city, state
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Your answer
Phone number
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Your answer
Dates available and preferred length of stay
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Your answer
How/where did you find out about the Savanna Hermitage?
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Your answer
Please describe in detail your daily, weekly, and/or regular practice of meditation, yoga, qigong and/or other relevant consciousness practices. Also include relevant training and/or experience.
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Your answer
Please describe in detail any interest and/or experience in eco housing, vegetable gardening, simple environmental living, vegan diet, and any other relevant information.
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Your answer
Please describe in detail any interest and/or experience in hiking, wilderness, and nature.
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Your answer
Please describe in detail any daily or regular physical exercise routine(s).
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Your answer
Please describe in detail any physical and/or mental illnesses or disabilities, including anxiety and/or depression, and if you are currently taking any medication for any mental illness.
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Your answer
Please describe in detail any arrest and/or criminal record.
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Your answer
Rate yourself on an introvert/extrovert scale
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very introverted
1
2
3
4
5
6
7
8
9
10
very extroverted
Your diet
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omnivore
plant based
vegetarian
vegan
raw food
Other:
Caffeine consumption
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none
rarely
once or twice a week
coffee or tea in the morning
throughout the day
Tobacco use, vaping, and/or other smoking
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None
Occasionally
Daily
Frequently throughout the day
Alcohol consumption
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none
rarely
1-5 drinks a week
6-10 drinks a week
10+ drinks a week
Consumption of cannabis/marijuana and other recreational or illegal drugs
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never
less than once a month
monthly to weekly
multiple times a week
daily
Video time (TV, movies, streaming, youtube, etc)
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none
rarely
less than 1 hour a day average
1-2 hours a day average
2-4 hours a day average
4+ hours a day average
Social media time (Facebook, Instagram, Twitter, TikTok, etc.)
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none
rarely
less than 30 minutes a day average
less than 1 hour a day average
1-2 hours a day average
2-4 hours a day average
4+ hours a day average
always online, connected to social media
How often do you read an entire book?
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Never
Less than one a year
One per 6-12 months
One per 2-5 months
One or two a month
Weekly
More than one book a week
A copy of your responses will be emailed to the address you provided.
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