Catalyst Course 2018 Back row Application Form
Thank you for your interest in back rowing on the Catalyst course.

Back rowing is a fantastic opportunity to be in service of Catalyst participants and return to Embercombe. It requires hard work, early mornings and late evenings. It is also tremendous fun, and a rich learning experience in its own right.

Please fill out this short form to log your details. Note that applicants must have previously attended the Catalyst course, and that filling out this form will not necessarily guarantee your first choice of course dates as we receive a large number of applicants.

What is your full name? *
Your answer
What is your email address? *
Your answer
What is your mobile number? *
Your answer
Have you Back Rowed before? *
Required
What are your preferred Catalyst Course dates for 2018? Please tick as many as you think you might be available for. *
Required
Emergency Contact and Health
This information is regarding health and safety for the courses and will not determine your likelihood of a place back rowing on a course. The information will be held in confidence by the Embercombe team.
Do you have any accessibility, physical or psychological health requirements we need to know about? This includes information on tasks that you might find difficult (e.g. carrying equipment) and medication you might be taking (e.g. epipens or medication for depression/anxiety)
Your answer
Do you have any special dietary requirements?
Your answer
Emergency contact name *
Your answer
Emergency contact number *
Your answer
Relation to you *
(e.g. parent)
Your answer
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