YWAM Valdemarpils NIKO Application

1. Personal Information
Name*

PrefixFirst NameMiddle NameLast Name
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Country CodeArea CodePhone Number
E-mail*
Date of Birth*

DayMonthYear
Sex*

MaleFemale
Citizenship/ Nationaliy:*
Please list the languages you speak and indicate your proficiency:
English*
Latvian*
Russian*
Other:
In Case of Emergency, Contact:*

First NameLast Name
Relationship: *
Father, Mother, Sister, etc.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Country CodeArea CodePhone Number
E-mail*
Are you a Christian?*

YesNo

Liability, Consent and Commitment
1. Release of Liability

I understand that every effort is made to provide a safe environment and that participation in a Youth With A Mission (Jaunatne ar Misiju) Latvia organized program, event or outreach is entirely at my own risk. I will personally obtain adequate health and accident insurance for all phases of my involvement with Youth With A Mission and hereby release YWAM, its staff, agents and volunteer assistants from any liability arising out of injury, damage or loss which may be sustained by me during my involvement with YWAM.
Type Your Name:*
Name of Parent or Guardian If Under 18

First NameLast Name
Date*

DayMonthYear
2. Release of Medical Information & Consent for Treatment:

I give permission for: (a) the release of relevant medical information to YWAM Latvia; (b) for YWAM Latvia to release relevant medical information to suitably qualified local medical personnel should I require treatment; (c) such treatment, anesthetics and operations as deemed necessary in the opinion of the attending physician.
Type Your Name:*
Name of Parent or Guardian If Under 18

First NameLast Name
Date*

DayMonthYear
3. Commitment:

As an applicant for a NIKO, I take the responsibility, if accepted as a participant for the NIKO, to obey all the rules and regulations governing my behaviour during this experience and to give my full attention and support to the NIKO's staff in order to make this event a success for all the participants.

YWAM Valdemārpils, Latvia is not responsible for sickness, death and unexpected travel expenses due to accidents, insect or/and animal bites.
Type Your Name:*
Name of Parent or Guardian If Under 18

First NameLast Name
Date*

DayMonthYear
Certification of the Agreement of Data Processing

With this, I certify my agreement that Youth With A Mission Latvia (registration number 90000158895) will collect, use and store my personal data for unlimited time for the purpose of this application form, providing that this data processing complies with the regulating laws of the EU and Latvia.

I personally have submitted my personal data to this organization. I am informed that I am entitled at any time to ask to renew my data, to request information about the use of my personal data, or to revoke the agreement given here and request the deletion of my data.
Type Your Name:*
Name of Parent or Guardian If Under 18

First NameLast Name
Date*

DayMonthYear
Data Protection Policy

With this, Youth With A Misison Latvia certifies that the information and personal data, which you have provided through this application form, will be collected, processed and stored in accordance with the EU regulating laws regarding personal data protection.

By providing your data, you agree that your data will be processed and stored for the duration of the data processing time, as well as in the events according to regulating laws after the initial data processing time, as long as it is needed.

In the event of acceptance I agree that I will be photographed during the program, and then pictures will be used for the publicity purposes for Youth With A Mission Latvia.

The collected data will not be given to any third parties, except for the University of the Nations Records System, or if it is required by the regulating laws.

At any time, you have the right to ask to renew your data, to request information about use of your personal data, or to request the deletion of your data.
Should be Empty:

1. Personal Information

MEDICAL HISTORY

Liability, Consent and Commitment