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 *
Clear selection
Name: *
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.
ID Number:
Date of Birth:
Home Language
Cell Phone: *
We will be creating a WhatsApp group to communicate with you. Please DOUBLE check that your number has 10 digits.
Address *
Where did you hear about WILD NIGHTS OUT from? *
Please state what "other" avenue you hear about it from:
I will be paying the R400 "PAY-IT-FORWARD" Donation via *
Wild Card Number:
Please quote your Wild Card Number if you have one.
Medical Aid Name:
Medical Aid Number:
Do you have any chronic medical conditions?
Are you currently on any medication?
Do you have any allergies?
Next-of-Kin Name: *
Next-of-Kin Surname:
Relationship to next of kin (mother, father, guardian, etc):
Next of Kin Cell Phone: *
Home Telephone:
Next-of-kin Email Address:
Thank you.
If there is anything else you feel we should know to ensure your safety on the trail, please leave comments here:
A copy of your responses will be emailed to the address you provided.
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