REGISTRATION_RIGHT LIVELIHOOD

PROGRAMME REGISTRATION

ALL FIELDS MUST BE COMPLETED.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Skype Name *

Nationality *

Emergency Contact Name *

Emergency Phone Number *

Dietary Needs - allergies, restrictions, preferences, etc. *

Supporting Statement

Please provide a statement of your reasons for applying for the course.
This should include:
1) what is the motivation or source of inspiration behind your interest in this program;
2) your high level vision of your right livelihood project, path or GNH prototype you would like to develop

Please stay within a limit of 500 words *

COMPUTER SKILLS

The course will include on-line learning, mentoring and support. Please tick the box to confirm that you are computer literate and have access to a regular on-line facility. *

YES

TRAVEL AND INSURANCE

Participants will be responsible for organizing their own travel to Canada and Bhutan. Participants are required to take out appropriate personal travel and health insurance to cover the residential module 2 in Bhutan. This will be necessary before the visa to Bhutan can be issued. I confirm I will be responsible for organizing my own appropriate health and travel insurance to cover the residential module in Bhutan. *

YES

FINANCIAL ASSISTANCE

To support a wide cross section of participation on our Right Livelihood Programme, we have a small bursary fund available. We try to ensure that our financial assistance helps those most in need and is shared amongst as many applicants as possible. It is limited to those who wouldn’t otherwise be able to attend. Please be aware that most bursaries for the Right Livelihood Programme are in the region of 10 - 15% of the course fee and do not cover travel or incidental expenses.

I would like to help sponsor a person who may not be able to pay the full fee *

YES

I would like to attend, but I need some help with the course fee *

YES

Submit

PHYSICAL AND PSYCHOLOGICAL WELL-BEING

Participants on the Right Livelihood Programme are fully responsible for their own physical and psychological well-being and are required to take out their own health and travel insurance to cover the residential programmes. It is important that participants are aware that the programme includes visiting different places in Bhutan involving travelling on rough and mountainous roads for long distances and walking pilgrimages in remote, rural and high altitude environments (above 3000 metres).

The Right Livelihood Programme, draws on a range of activities and approaches to cultivate mindfulness and self-reflection. However, these are not intended to serve as a substitute for psychotherapy, psychiatric treatment or medication of any kind. If you are currently following a treatment and/or are taking medication (for a physical or psychological condition), we ask you to first consult your doctor or therapist to see whether it is appropriate for you to join the Programme. We also ask you to not interrupt any current treatment and/or medication. The Right Livelihood Programme does not accept any responsibility in this regard. We reserve the right to ask those who are a serious threat to others or to themselves to leave the program and to seek professional help elsewhere.

Please complete the following questions about your physical and psychological well-being.

PHYSICAL AND PSYCHOLOGICAL HISTORY

Please complete the following questions about your physical and psychological well-being.

* Indicates required field

Name *

First

Last

Email *

Module 2 in Bhutan involves walking pilgrimages in remote, rural and high altitude environments where medical facilities are basic. If you have any mobility or special needs then it may be possible to arrange alternative activities . Please provide information about any mobility or special needs. *

Do you have any history of physical illness or any disabilities, which may affect your participation in the Right Livelihood Programme? *

Have you ever been diagnosed with or experienced any mental health issues e.g. depression, eating disorders, anxiety, drug/alcohol abuse? If yes, please give details of condition(s) and date(s). *

Are you taking any medication for any physical or psychological condition? If yes, please give details of condition and medication. *

EMERGENCY CONTACT DETAILS

Name of someone we can contact in case of emergency: *

Emergency Contact Phone Number *

I agree to take full responsibility for myself during the Right Livelihood Programme. I understand that all participants need to observe the terms and conditions, take out appropriate health and travel insurance, and that the programme is undertaken and continued with the agreement of the teachers. *

YES

Participant Signature. Please type in your full name in lieu of a signature *

Date *