APPLICATION FORM
Trip: Dates:
Name:(as it appears on your passport)
Address:
Postcode:
Contact numbers:Daytime:
Evening:
Mobile:
Email Address:
Date of Birth:
Length of time that you have been involved in Lifecentral Church:
Name of small group leaders if involved in a small group:
If you are not involved in a small group, please give the name and address of two people who have known you well over the last three years who could be contacted to provide a reference:
Reason that you would like to go on this project:
Please list any medical needs/disabilities/dietary requirements that you have:
Write a paragraph about your faith:
What do you feel that you can give to the team? Include details of any skills or talents which would be useful on this project e.g. music, art, drama, first aid etc:
What experience do you have of working with children? e.g. Church activities, babysitting/child-minding, parenting, teaching etc:
List any previous missions or overseas projects in which you have been involved. Please include the name of the organisation that you went with and the dates:
Do you already have a current Criminal Records Bureau clearance certificate issued by this organisation?
Yes / No
If no, it will be necessary for one to be obtained and we will advise you of the simple procedure for this.
I confirm that all the information given above is accurate and complete.
I confirm that I have a passport that is valid until the end of:
(date must be 6 months after the end of trip)
I confirm that my spouse/family is fully supportive of my participation in this trip.
I confirm that I am able to meet the pre and post trip requirements.
I understand that whilst the Church will do everything possible to ensure that the trip runs smoothly, I am responsible for my own health and safety.
I am happy for you to contact my small group leaders for a reference, or to contact the other referees that I have named.
Signed: Date:
For parents/guardians of applicants under 18.
I give my permission for my son/daughter to take part in this project.
Signed: Date:
Name:
Please complete and return to: John Cockling
LIFECENTRAL CHURCH, Little Cornbow, Halesowen, West Midlands, B63 3AJ
T: 0121 501 3542