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ENROLL HERE:

Fill out the application below to enroll!

First name

Email

Last name

Phone

Address

Date of birth

Requested Start Date

Values: Please list your core values.

Motives: What motivates you in life?

Beliefs: What are your key beliefs that support your life?

Skills: What skills do you bring to community?

Where do you see yourself serving within the community?

Why do you want to be part of this community?

How do you define wellness?

How long have you been commited to your wellness?

Are you currently on medication? *

Yes

No

Are you willing to take a drug test? *

Yes

No

Are you willing to submit to a background check? *

Yes

No

Have you been convicted of any violent crimes? *

Yes

No

If yes, please explain:

Tell us about your experience living in a community setting:

Describe how you handle conflict resolution and provide examples:

Are you committed to a minimum of 15 hours of Wellness practices per week? *

Yes

No

Do you have any allergies or dietary restrictions?

Yes

No

If yes, please list:

Do you have any physical or mental health conditions we should be aware of? *

Yes

No

If yes, please describe:

Do you have a support system in place? (family, friends, sponsors)

Yes

No

If yes, please describe:

What resources do you feel you need to support your wellness?

What are your short-term goals (next 6 months)?

What are your long-term goals (next 5 years)?

How do you plan to achieve these goals?

How did you find out about us?

Reference 1 Name:

Relationship:

Phone Number:

Email Address:

Reference 2 Name:

Relationship:

Phone Number:

Email Address:

Emergency Contact 1 Name:

Relationship:

Phone Number:

Emergency Contact 2 Name:

Relationship:

Phone Number:

Upload Resume

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Upload BIO

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Your Signature

By checking the box below, I acknowledge that I have read, understood, and agree to abide by the terms and conditions outlined below. I understand that my residency at Reconnection Camp is contingent upon my compliance with these terms and that failure to do so may result in my removal from the property.

I acknowledge and accept the following terms and conditions as a future participant of TribaLights Program:terms and conditions

Thank you! We will reach out soon.

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