SYNERGY COMMUNITY FARMS & TEMPLE OF TANTRA
STUDENT APPLICATION

Copy and paste this form to your email that you are sending to us at synergyfarms@aol.com.  Or print it and fill it out and mail it. Or if you have received this form in an email, you may fill in this form and return it by clicking "reply" on your email program and filling in the blanks. If more than two people are registering and you are sending by mail, copy this registration form for additional person or couple and send forms in same envelope.   If you are a couple, each person must complete a separate application.

First Name ___________________________  Last Name  _____________________________ 

I am male ____   female _____  

Birth date:  Month ________  Day ________  Year ______  
(you must be 18 or older)

Email  _________________________________

Telephone:    Home (____)_______________________,  Work: (____)_______________________ 

                    Cell:(____)_________________________

Address: Street _________________________________ City: _________________________________ 

State/Province: ___________________________  Zip: ______________  

Country: _______________________

Nearest Living Relative: ___________________________________________

Who should we notify in case of emergency?  Please provide contact information (name, phone, email, address)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

Professional References: (list name, phone, email, address)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

Personal References: (list name, phone, email, address)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

Where did you work before coming here? (list name, phone, email, address)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

Currently Employed by: __________________________________________________

Address _________________________________,  Phone: ________________________________

What do you do to earn a living? ______________________________________________________
 

Legal ID: Type _____________   Number: ________________ Country___________ State ____________

What are your major skills and talents that would contribute to community living?

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

ATTRIBUTES, CHARACTERISTICS, TALENTS & SKILLS
Rate your skills, experience and abilities in the following fields, attributes, skill sets and
qualities on a scale of one to five, five being the highest and one being the lowest

SKILL/TALENT
  1 2 3 4 5   1 2 3 4 5   1 2 3 4 5
Animal Husbandry           Farming           Organizing          
Architecture           Filing           Permaculture          
Art           Fishing           Programming          
Carpentry           Gardening           Promotions          
Cleaning           Graphic Design           Psychology          
Clerical Work           Handy Man or Woman           Painting          
Cooking           Hot Tubs, Pools & Spas           Plumbing          
Communications           Irrigation           Ponds/Koi, Fish          
Computers           Landscaping           Recycling          
Construction           Laundry           Sales          
Counseling           Management           Secretarial          
Data Entry           Massage           Sewing          
Decorating           Marketing           Tantra          
Energy Systems           Networking           Web Design          
Electrical           Office Work           Yoga          
 

CHARACTERISTICS
  1 2 3 4 5   1 2 3 4 5   1 2 3 4 5   1 2 3 4 5
Adventurous           Generous           Loyal           Reflective          
Animal Lover           Gentle           Loving           Religious          
Athletic           Good Communicator           Manipulative           Respectful          
Articulate           Graceful           Mature           Scared          
Bold           Gracious           Meditative           Secretive          
Brave           Greedy           Meticulous           Self Confident          
Artistic           Caring           Mindful           Self Starter          
Cautious           Happy           Musical           Sensual          
Clean           Healthy           Nature Lover           Sexual          
Centered           Honest           Neat           Sharing          
Childlike           Humanitarian           Nervous           Shy          
Clean           Humorous           Neurotic           Sly          
Clumsy           Innocent           Nurturing           Spiritual          
Compassionate           Integrity           Open Minded           Strong          
Compersive           Interesting           Orderly           Tactful          
Compulsive           Intelligent           Organized           Thorough          
Conscious           Introverted           Passionate           Timely          
Conservative           Intuitive           Patient           Tolerant          
Curious           Jealous           Peaceful           Trustworthy          
Detail-Oriented           Joyous           Persuasive           Truthful          
Drama Free           Kind           Playful           Willful          
Environmentally Conscious           Liberal           Prejudiced           Wise          
Ethical           Logical           Punctual           Wishy Washy          
Extroverted                                              

What else would you like to tell us about your skills, qualities, characteristics and talents?

What is your citizenship? __________________________

What's your religion or spiritual belief system? ___________________________________

     What are your thoughts about television?

We have periods of silence, how do you feel about that?

Our community is drug, smoke, alcohol and drama free and these things are not permitted on the property.  What do you think of that?

Do you or did you ever smoke?
If so, what do or did you smoke?                                 How much?

If you quit, when did you quit? 
Do you ever have relapses?

Do you or did you drink alcohol?
If so, what do or did you like to drink?                          How much?    

If you quit, when did you quit? 
Do you ever have relapses?                

Do you or did you use or take drugs?
If so, what do you or did you use or take?                     How much?

If you quit, when did you quit? 
Do you ever have relapses?

Do you have any health issues?
If so, please list.                             

What are you doing to address your health issues?

Do you have any physical, emotional, psychological or mental limitations?
If so, please list.

What do you do to address your limitations?

Do you have any allergies?
If so, please list.

What do you take or do for your allergies?

What do we need to know about your health?

Are you current taking any medications? 
If so, what are you taking?

Have you ever been hospitalized? 
If so, what for?

Have you ever had problems with drugs?
If so, how did you treat it?

Have you ever been treated for mental illness or emotional problems? 
If so, how did you treat it?

Have you ever had problems with alcohol?
If so, how did you treat it?

Have you ever been addicted to smoking?
If so, how did you treat your addiction?

What is your intention in coming to the community?

What do you know about living in community? 
 
Do you have any experience with community?

Do you recycle?       
Do you consider yourself environmentally conscious?

What is your current relationship status?  Married, single, divorced, widowed, other?  

Have you ever been married? 

Are you familiar with tantra?  Describe any experience you have with tantra.

How tolerant are you to other people’s sexual or lifestyle orientations?

What are your attitudes about sex?

What are your attitudes about nudity?

What are your attitudes about children? 

 Do you want children? 

 Are you comfortable around children?   

Would you prefer to be in an environment with or without children?

Do you have any dependents?  If you have children or dependents, please tell us about them. How many?  How old are they?

Do you have a website?

What is your career?

What is your passion?

What do you need for your happiness?

What's your educational background?

What languages do you speak?  Read?  Write?  

What’s your relationship to nature?

Do you like music?  If so, what kind?

Do you sing or play any instruments? If so, tell us about it.

Do you have any experience with farming, gardening or agriculture?

How do you feel about dogs, cats, animals?

Why do you believe you are ideal for this community?

What did you like about our websites www.synergycommunity.com?

What are your other skills? Interests?

Are you carnivore/omnivore/vegetarian/vegan/raw?

What are you attitudes about others' food choices?

What else would you like us to know about yourself?

What questions do you think would be good to include on this application?

I verify that I am 18 or older: Signature ___________________________________

Please provide a copy of a valid government approved form of ID.

For your safety and ours we perform an extensive background check.  You will be required to pay a non-refundable fee of $25 for your background check if you are selected for our program.

SYNERGY COMMUNITY FARMS WAIVER OF LIABILITY AGREEMENT

I understand that Synergy Community (SC) /Synergy Farms (SF) /Synergy Services, Inc.(SSI) is located in a rustic, hilly and wild area. I and my assignees, heirs, personal and legal representatives, release from liability, hold harmless and will not make any claims (present and future) against Synergy Community (SC) /Synergy Farms (SF) /Synergy Services, Inc.(SSI) or any of its staff, agents, contractors, guests or volunteers for any physical or emotional injury, including death, that may occur to me and accompanying children, animals or adults at Synergy Community (SC) /Synergy Farms (SF) /Synergy Services, Inc.(SSI) ; including but not limited to slipping and falling, use of any pools or water including infections or drowning and use of any trails; including but not limited to any loss of any kind to my property or vehicle, whether resulting from my own acts, the acts of others, acts of God or from acts of any Synergy Community (SC) /Synergy Farms (SF) /Synergy Services, Inc.(SSI) staff, agents, contractors or volunteers. Synergy Community is a private, spiritual members-only organization and reserves the right to terminate the tenancy of a guest or member for reasons Synergy Community (SC) /Synergy Farms (SF) /Synergy Services, Inc.(SSI) shall deem objectionable
 

I agree to the terms and conditions of this agreement:

Address _________________________________ City _____________________
State/Province __________________________ Zip Code ____________  Country ___________
Phone ____________________ Mobile ___________________
Email ____________________________ Email ____________________________
Vehicle Make ___________________ Vehicle Model ______________________
Vehicle Color ___________________________ Car License ______________________
Arrival Date _______________________  Departure Date ___________________
Member Name ____________________________ Supervisor’s Name ______________________
Member Signature: _________________________ Supervisor’s Signature ____________________
Date ___/___/___ Date ___/___/___

Mail Registration Form to: Synergy Community Farms, 1371 Malaihi Road, Wailuku, Maui, HI 96793 (808) 244-4921 or email to synergyfarms@aol.com. 

Do not complete below this line:


Start Date ___/___/___    End Date ___/___/___

Position: __________________________    Manager:______________________

Duties and responsibilities: ___________________________________________________________________________

___________________________________________________________________________