Once this form has been submitted you will have agreed to participate on the Barefoot University Foundation Programme and to pay the fees you have agreed to.
Your contact details:
Surname:
First name(s):
Email Address: (Double check!)
Telephone no
(+ international calling code):
Full Postal Address including Postal code:
Family or Friend that can be contacted in an emergency.
Please make sure they have the relevant information in this case.
Surname:
First name(s):
Relation to you:
Email Address: (Double check!)

Home telephone no
(+ international calling code):

Work telephone no
(+ international calling code):

Cell/mobile telephone no
(+ international calling code):
Full Postal Address including Postal code:

Details about you; your project and duration of stay:
Passport Number/ID:
Country of Origin:
Length of Volunteer Period:
Expected Date of Arrival in South Africa:
Expected Date of Arrival at Khoinania:
Expected Date of Work Commencement:
Expected Date of Work Ending:
Expected Length of Stay in South Africa (including any traveling time you may wish to allow yourself):
Preferred main project:
Age:
Date of Birth:
Gender:
Please ensure that you have comprehensive insurance cover.

Please specify how you wish to pay:

Please select a payment option

You will be contacted as soon as possible after submitting this form.
Thank you for registering with Barefoot University.