Bush Tribe Application Form.
Hello, and welcome -

Once you've filled out the form, we will email you with the next steps.

PLEASE NOTE: this might take a few days - so please be patient.

Yours in health, friendship and sobriety,
Shanna Xx

(CEO/Founder)

Consent *
I consent to my data being collected and stored by Sober in the Country Ltd (SITC) for the purpose of assessing my suitability to join this peer group,  and, in anonymised form, for the purposes of helping SITC with their work and research.
Required
First Name (your legal first name) *
* Member requests without these details won't be processed.
Surname (your legal last name) *
* Member requests without these details won't be processed.
Anonymity. *
We run the Bush Tribe through a Facebook private group because this is what's familiar to most users - and because these groups now have the added function / option for users posting anonymously. We ask that if you have ANY concerns about sensitive questions that you use this function. This is your responsibility.
What is your Facebook name? *
Some of us change our Facebook names for privacy. That's 100% fine; please just let us know what your ''Facebook name'' is here so that we can match it up when we approve you into the group :
Rural residential address? *
*Forms without full and complete address will not be processed.
Gender *
What is your occupation / business / role? *
Social Circumstances? *
What is the nature of your immediate social circumstances (eg; living alone, with a partner, children, housemate, etc?)
Email Address *
* if you have any concerns about confidentiality choose a personal email. This is your responsibility.
Date of Birth *
MM
/
DD
/
YYYY
Mobile Phone Number *
* this will not be used unless it's critical.
If you've already quit drinking - do you have a sober anniversary date - and if so, by stating it, confirm and give permission that we can totally celebrate with you and the group?
MM
/
DD
/
YYYY
Which of these best describes where you're at? *
You can pick more than one
Required
Please tell us (be as honest as you can) about what you hope to change or achieve by being part of our tribe? There are no right or wrong answers. It could be long or short term goals. Whatever you feel comfortable sharing with us. *
Please tick YES to acknowledge you're here to help yourself and not to support a friend or family member and that you're also NOT a professional here to use the group for your own gain. That is not our purpose. *
Do you acknowledge that being in this group is not a substitute for a recovery programme, one-on-one counselling, professional advice, or emergencies. *
If you're here to try stop alcohol use altogether have you got a programme/s or method/s in mind to use and follow? *
HELP US FIGHT FOR YOU ! *
Have you tried to get help or support in your community previously and felt like nothing ''resonated'' or made sense for you? If so, please tell us a little about that experience. This is the CRITICAL information we can use and pass on to leaders and politicians in our fight for change.
HOME-BASED detox - could this help you? *
SITC has partnered with a new organisation who deliver hone-based tele-health detox support. If you think you need support to safely detox with support from home - please let us know - and we will send you the eligibility criteria and follow up.
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This form was created inside of Sober in the Country Ltd.