Visitor Application

Address

Street Address

City

State

Country

Postal code

How did you hear about Earthwaking Village?

Gender

Male

Female

Please list 2 Emergency Contact People (include their name AND phone number with country code) *

What are the names+ages of the people you are requesting to bring with you? *

Please explain why you answered that way *

Are you interested in investment opportunities within an Earthwaking Village? (For serious interest, please reach out to Melinda/Jonathan England) *

Are you interested in opportunities to contribute to the village in exchange for a bed or room within a community home/meals/village amenities (AVAILABLE!) *Opportunities available in kitchen, garden, maintenance and other areas *

Yes

No

Please explain why you answered that way. *

Have you read the book “If I Die Before I Wake” by Jonathan England? *

Yes, I have read it

No, but I commit to reading it before I arrive

No, and I will not read it

What Earthwaking events have you attended? Please share when and how many times for each event. *

What Earthwaking programs are you currently in or have you completed? Please share when you joined and your current status in each program. *

Explain why you assessed yourself at that level *

What things cause you to be triggered? (please explain) *

What does it look like when you are triggered (Fight, Flight, Freeze, Appease)? For example: Attack, Withdraw, Get Angry, etc. (please explain) *

How do you want others to deal with you when you are triggered? (please explain) *

Do you consider yourself a “me” person or a “we” person? Why? (please explain) *

What percentage of your life are you at the source of and completely responsible for? *

What three words best represent the things you have found to be missing in the world? *

Please explain why you answered that way. *

What physical dis-ease, syndromes, disorders, demons, ailments etc do you currently have? *

What is your relationship with ANY mind/body altering substances including plant/animal medicine, alcohol, prescription medication? If you use any, what and how often? *

What is your occupation / vocation? *

What gifts, talents / abilities come naturally to you and would enhance our Village? *

What do you feel your natural role would be in a thriving Village? *

Why do you want to join the village *

Is there anything that you feel you may be running from in the "old world" as you transition your life into the New Earth Villages? *

What are you willing to live/die for? *

What is the #1 thing you wouldn't/couldn't say "no" to. What distraction/attachments have pulled you off Purpose/Mission in the past? *

Currently there is very limited to zero space to allow for pets in the community. Are there pets that you need to consider in your move to an Earthwaking Village? What is the breed/age/personality/ability to get along with other animals (cats/dogs/livestock) and children? *

Where you are going matters more to our mission than where you have been AND understanding where you have been is also important so that we can help you identify your egoic tendencies, ruts and patterns and hold you accountable for being your True Self. Do you consent to a background check and if so, what would be found? Full transparency and congruency of being is very important to us. To not disclose criminal charges is to choose not visit/live in an Earthwaking Village. Please respond with "I consent" or "I do not consent" followed by an optional description. *

Have you received any Covid Vaccinations? *

Yes, 1

Yes, more than 1

No

Please share your stand regarding your above decision. *

What other things do you want us to know in making a decision regarding your application? *

Earthwaking Village

Visitor Application

Thank you for your interest in living in an Earthwaking Village!