Thank you for applying to be on team! Please completeALL sections of the following form in order for Soul Survivor to process your application.Please simply fill in the form by typing in the available spaces and email it back to along with a passport photo. Alternatively print it out with a photo and post it to the address at the bottom of the second page.

**Soul Survivor is a 5 day event please make sure you check the team description so you are available

forALL days your team requires - this may mean you are needed for set up or pack down daysdirectly

before and after your chosen week**

Personal Details

Title / Gender / M/F / Date of Birth / We will not process your application without your DOB
First name / Surname
Phone Number / (mobile) / (home)
Email address
Address

If you have any dietary requirements please email however, although we will do our best, we cannot guarantee any requests made after the 15th July 2011.

Team Applying for

A list of the teams available is on the website. Please note if your first team choice is full you will automatically be allocated to your second choice. If neither choice is available, you will be allocated to the team most in need of your help (but not a team needing particular qualifications or experience).

First choice / Event / A B C or MomentumDelete as appropriate
Second Choice

Referee Details

Please give us your church leader’s details so we can contact them for a reference. If your minister is a relative please give the details of someone else on the Church Leadership Team.

Please note this information is ESSENTIAL to your application. We will not be able to process your application without obtaining a reference for you.

Title
Full Name
Leadership role
Email address
Phone Number
Address

Who do you want to camp with?

We can only put you with a requested group if you have their booking reference number and group leaders full name

Teams village

Your church group/friends/someone else:

Their full name
Booking ref

Please let us know the type of accommodation you are bringing (caravan, tent etc) and if you are sharing this with other team members/delegates:

Skills/Experience

What skills and experience do you have that are relevant to the role?

Are you involved in church or voluntary work?

Self Disclosure

The nature of this event means that you must tell us about any convictions (pending, spent or unspent) and any cautions you have received.

Have you ever been convicted of an offence in any criminal proceeding, in any court, in any country? (For motoring offences please only answer YES if it resulted in disqualification).

YesNo If yes please give details:

Has your conduct ever caused mental or physical harm to a child / young person or put a child at risk? To your knowledge, has it ever been alleged that your conduct has resulted in any of those things?

YesNo If yes please give details:

Do you have any ongoing health conditions? Please include details of any disability or depressive illness.

YesNo If yes please give details:

Does this health condition affect you working with children and young people?

YesNo If yes please give details:

FAILURE TO DISCLOSE INFORMATION, WHICH SUBSEQUENTLY COMES TO LIGHT, COULD RESULT IN IMMEDIATELY BEING ASKED TO LEAVE SITE.

Child Protection Policy

Soul Survivor recognises the unique status of children/young people, and seeks to ensure that they are respectfully treated as individuals. All workers, paid and voluntary, may be in contact with children/young people and consequently must accept that their welfare is paramount. As a team member in cases of abuse you must follow the procedure set out by Soul Survivor at the beginning of the event. Our full child protection policy is available todownload from the Soul Survivor website. Although your team leaders will go through it at your chosen event please make sure you are familiar with these guidelines before coming to site. Copies are available by email on request.

I agree to abide by the child protection procedures and guidelines laid down by Soul Survivor before and during the event. I certify the information I have provided is true to the best of my knowledge and belief.

Signature / Date

Please return this completed booking form to:

OR POST IT TOTeams, Soul Survivor, Unit 2 Paramount Industrial Estate,

Sandown Road,Watford, WD24 7XF

Soul Survivor is a company limited by guarantee in England and Wales no. 03991111. Soul Survivor is a registered charity.

Registered Charity number 1080720.