SYNERGY COMMUNITY FARMS & TEMPLE OF TANTRA ASHRAM ~ MEMBER APPLICATION

If you wish to be a Residential Member of Synergy Community and the Temple of Tantra, copy and paste this form to your email that you are sending to us at synergyfarms@gmail.com.

Or print out this form and fill it out and mail it to Synergy Farms, 1371 Malaihi Road, Wailuku, HI  96793.  Print icon is at the bottom of the page.

Residential Members commit and pay for a minimum of 6 months to stay at the Temple of Tantra/Synergy Community Farms as per Maui County Zoning Codes. 

 

First Name ___________________________  Last Name  _____________________________

I am male ____   female _____                                   SS# ____  ____  _______

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

Email  _________________________________

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

Cell:(____)_________________________

Address: Street _________________________________ City: _________________________________

State/Province: ___________________________  Zip: ______________

Country: _______________________

When will you arrive? ___/____/____          When will you depart?  ___/___/___

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

Departments: (Select 1st and 2nd options) – Choose two from the following indicating 1st and 2nd preference: Department:   1 __,     2 __,     3 __,     4 __,    5 __

1) Housekeeping
2) Landscaping
3) Maintenance
4) Office
5) Security

(Note: You will be assigned one primary and one secondary department)

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

Do you a source of income?  Y/N ____  If so, what is your source of income?

Do you have transportation?  Y/N ___  If so, what kind of vehicle do you have?

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 $50 for your background check if you are selected for our program.

 

SYNERGY COMMUNITY & TEMPLE OF TANTRA
WAIVER OF LIABILITY AGREEMENT

I understand that Synergy Community (SC) Temple of Tantra (TT) 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) Temple of Tantra (TT) 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) Temple of Tantra (TT); 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) Temple of Tantra (TT) 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) Temple of Tantra (TT) shall deem objectionable. This form must be approved by one of the head administrators of the Temple of Tantra.
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 ___________________
Guest Signature____________________________ Guest Printed _________________________
Date ___/___/___
Sponsor Signature: ______________________ Sponsor Printed _______________________________
Date ___/___/___
Approval Signature____________________________ Approval Printed ____________________
Date ___/___/___

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

Please note:  Security deposit of $600 plus first month’s tithe is due upon acceptance of your application in order to reserve your time and space.  Refunds must be in writing.  Date of receipt determines amount refunded.

ALL Refunds are subject to a $75 processing fee.  Requests made 30 days or less before arrival date are subject to a 50% processing fee.  No refund if request is 7 days or less from arrival date.

You must complete your contract and give a 30 day notice at the end of the 6 month commitment, leave your place neat, clean and undamaged with all items in tact in order to get your deposit back.

Deposit will be mailed to your forwarding address in approximately 2 weeks and is not given at the time of departure.

We look forward to hearing from you.

Do not complete below this line:


Start Date ___/___/___    End Date ___/___/___Position: __________________________    Manager:______________________Duties and responsibilities: ______________________________________________________________________________________________________________________________________________________