EcoExperience Registration Form

Registration takes about 10 minutes to complete.

• All studies are in English although Hebrew is the common language used day to day on the kibbutz.
• Notifications of acceptance will be made on a rolling basis according to space availability, generally within 2 weeks of the receipt of an application.
• Accommodations may be shared.
• It is possible to extend per day after a minimum of 4 nights.
• 4 night minimum stay $260, $65 USD for each additional night

• Tasks are varied and can include strenuous work in the Arava desert's extreme weather.


To register, please complete and sign this form.

Please feel free to contact us with any questions you may have with regards to the EcoExperience at Kibbutz Lotan.

admissions@klotan.co.il

Center for Creative Ecology
Kibbutz Lotan
Hevel Eilot
885500 Israel

EcoExperience Registration Form

(Please type directly on the form. Use the tab key to move between fields. Check boxes by clicking with the mouse.)

First Name *
Your answer
Last Name *
Your answer
Date of Birth *
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Gender *
Passport Number / ID *
Your answer
Nationality *
Your answer
Requested Arrival Date *
Please note the EcoExperience starts every Sunday. You may request any dates you choose throughout the year (with the exception of the Jewish holiday periods of Pesach, Rosh HaShana and Succot), but acceptance is dependent on available space. We will confirm your booking by email. Minimum stay is 4 nights, it is possible to stay for longer.
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Requested Departure Date *
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Email Address *
Your answer
Home Address *
Your answer
Phone *
Your answer
Please tell us about any relevant past experiences you have had. *
Your answer
Please tell us what you are hoping to gain from your time at the Center for Creative Ecology. *
Your answer
How did you hear about us? *
Please indicate the appropriate assessment (in your opinion) of your present health *
Do you suffer from any major health problems? *
Please provide as many details as you can
Your answer
Are you taking any medications on a regular basis? *
Your answer
Have you ever been hospitalized? *
Please give details
Your answer
Present or past health issues *
I hereby declare that I have suffered, or presently suffer from, the following conditions:
Required
If you checked any of the boxes above, please give details: *
Your answer
When was the last time you were examined by a licensed physician for the above named conditions? *
Your answer
Declaration of Health Status *
1. I agree to disclose to the doctors and to any medical caregiver who shall examine me, full and correct information concerning every illness and defective condition that I have experienced in the past, and that I do not suffer from said illnesses today, and that I am not concealing information. 2. I hereby waive my right of medical confidentiality to Kibbutz Lotan, concerning any illness or condition that I suffered in the past, or that I suffer from today. I hereby agree that any physician or medical institution that shall treat me, will disclose full information regarding the above, and shall not lodge any complaint or suit of any kind to a health fund or its employees involved in forwarding the above-mentioned facts, or conclusions based on them. E-signature:
Your answer
Signed declaration *
I declare that the details I have given in this form are all true. I am aware of the following Lotan norms and arrangements: 1. Possession of illegal drugs or participation in other illegal activity according to the laws of the State of Israel will result in being turned over to the police and being asked to leave the kibbutz. 2. Excessive use of alcohol may be grounds for dismissal from the program. 3. Participants may not keep pets. 4. NO SMOKING is allowed in rooms or in any undesignated area. 5. Participants may not remove furniture from their rooms, nor may they make structural changes, paint on walls etc. 6. Participants may invite guests only with permission. They will be charged for their guests' meals. 7. Participants are expected to participate in all educational activities organized on their behalf. E-Signature:
Your answer
Date *
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