The Giufà Project Application Form

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Full Name *

Date of Birth *

YYYY

Current age *

Gender *

Female

Male

Prefer not to say

Other:

Nationality *

Country of residence

Contact Details

Home Telephone *

Mobile (parent/guardian if under 16) *

Email address (parent/guardian if under 16) *

Home address *

Emergency contact details

Parent/Guardian mobile *

Parent/Guardian Name *

Accommodation

We are able to offer a small number of residential spaces on site in Battle. Please answer below if you would benefit from being able to stay on site.

The Giufà project is a residency based at Battle Abbey. Are you able to get to Battle? *

Yes

Not sure

If your circumstances do not fit in the following options, please select OTHER and write a brief description of your circumstances. *

I live far away from Battle and would need to stay on site.

I am able to get a lift to Battle or public transport each day as I live within a commutable distance.

I would need help with the cost of travel to Battle, so staying on site would be helpful.

Other:

Are you able to offer a lift to other participants if required? *

Yes

Maybe

Medical Information

Please provide details of any medical conditions we should be aware of. This does not affect your place on the project but will help us to keep you safe.

Please select *

Wheelchair user or mobility difficulties

Blind or partially sighted

Mental Health difficulties

Deaf or hearing impairment

Autistic Spectrum Disorder / Asperger Syndrome

Disability, special need or medical condition not listed above

Allergies

No medical conditions

Other:

Required

Please enter details of medical conditions or allergies

Do you have any special dietary requirements?

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