WILD NIGHTS OUT 2019 - Application form
WILD NIGHTS OUT happens only once a year and is for any Matric student who wants to do something different to celebrate and mark the enormous milestone of finishing school. Places are limited to 24 people.
Email address *
Name: *
Your answer
Surname:
Your answer
APPLICATION QUESTION
Why do you want to come on WILD NIGHTS OUT? *
Why do you feel you should be one of the participants? Please really consider your reasons and then share them here. The more personalized and detailed the better. Your response is what will be considered most carefully in allocating places on WILD NIGHTS OUT The more effort you put in the more likely it is that you will be allocated a place. The ability to answer these kinds of questions is a real life skill, so use this opportunity to practice... enjoy telling us who you are and why you should be here.
Your answer
ID Number:
Your answer
Date of Birth:
Your answer
Gender:
Home Language
Your answer
Cell Phone: *
We will be creating a WhatsApp group to communicate with you. Please DOUBLE check that your number has 10 digits.
Your answer
Where did you hear about WILD NIGHTS OUT from? *
Required
Please state what "other" avenue you hear about it from:
Your answer
I will be paying the R400 "PAY-IT-FORWARD" Donation via *
Wild Card Number:
Please quote your Wild Card Number if you have one.
Your answer
Medical Aid Name:
Your answer
Medical Aid Number:
Your answer
Do you have any chronic medical conditions?
Your answer
Are you currently on any medication?
Your answer
Do you have any allergies?
Your answer
Next-of-Kin Name: *
Your answer
Next-of-Kin Surname:
Your answer
Relationship to next of kin (mother, father, guardian, etc):
Your answer
Next of Kin Cell Phone: *
Your answer
Home Telephone:
Your answer
Next-of-kin Email Address:
Your answer
Thank you.
If there is anything else you feel we should know to ensure your safety on the trail, please leave comments here:
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A copy of your responses will be emailed to the address you provided.
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