Fields marked with a * are required


Discover Eden Course Name *

Do you have any relevant experience or qualifications? *

Do you have any medical or health issues which may affect you during your placement? *

Are you taking any medication we should be aware of? *

Do you have any other special needs that would be helpful for the coordinators to know about? *

Do you have any special dietary requirements? E.g. Allergies or dietary preferences such as vegetarian *

Clothing size for unisex t-shirt *

I confirm that I will inform of any important changes to my health, medication or needs, and also of any changes to my address or to any of the phone numbers given above. Should I, the applicant, require emergency hospital treatment, I authorise a staff member of Discover Eden Pty ltd to sign on my behalf any written form of consent required by the hospital. In the event of illness or an accident, I give permission for first aid to be administered where considered necessary by a trained first aider, if available or medical treatment to be administered by a suitably qualified medical practitioner. I understand that all travelling, given tasks and activities are done at my own risk. I confirm that I have received, read, and understood a copy of the terms and conditions from Discover Eden Pty ltd. I confirm that I will have valid travel insurance throughout my stay with Discover Eden and that I will present proof of this document on arrival. I confirm that the above details are correct to the best of my knowledge.

I would like to receive Discover Eden News & Information

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Dr Mark Brown & Elton du Plooy of Discover Eden