CAR - STUDENT APPLICATION

CHILDREN AT RISK APPLICATION
PERSONAL INFORMATION:
Name *

First Name Middle NameLast Name
Address*

Street Address 1

Street Address 2

CityState / Province

Country and Postal / Zip Code
E-mail address*
example@example.com
Phone *
Birth date *

DayMonthYear
Height and weight*
Gender: *
Age*
Passport number*
City and country where it was issued*
Passport expiry date

DayMonthYear
Nationality (Country)*
Marital Status *

SingleEngagedMarriedSeparatedDivorcedWidowed
Children accompany you?

YesNo
Spouse's name
Children's Names / Birthday date / Sex / Grade in school
HOME CHURCH
Name of home church *
How long have you attended?*
Pastor’s name*
Do you have a role in the church?*
Pastor’s phone*
Pastor's email address*
example@example.com
IN CASE OF EMERGENCY CONTACT:
Name *
Relationship*
Ex: Mother
Phone*
Please enter a valid phone number
Email address*
example@example.com
Recent photo of face (passport type)*

JPEG ou PNG
Cancelof

SCHOOL EDUCATION/EMPLOYMENT/SKILLS
Highest level of education completed:*
Graduated in:*
What language do you speak in order of fluency:*
YWAM experience
Where & when did you do your DTS?*
Name of base leader
What base are you presently working?
Email of base leader
Questions
1. Describe your conversion experience and present relationship with the Lord.*
2. Describe other significant spiritual experiences you have had in your walk with the Lord.*

3. How would you describe your relationship with your family? Are they Christian?*
4. How would you evaluate your childhood?*
5. Tell us briefly about your experiences in YWAM and/or other mission organizations.*
6. Explain why you would like to do this school. Do you have a specific area where you would like to work, or would you like to decide after knowing the project better?*
7. If you are married and/or have children, how do you see your family participating in this ministry?*
8. If you are separated or divorced, explain briefly how this happened?*
9. If you are dating or engaged, how do you see the involvement of your fiance in your calling to work with children?*

FINANCIAL INFORMATION: Do you have all the money to pay the school? If no, how much do you have? Do you owe YWAM fees or tuiton to other YWAM bases that might interfere with you honoring your financial commitment to this school?
I hereby releasae Youth With A Mission, and all it's agents, volunteers, and any other person that work with YWAM as a staff member or volunteer from any liabiltity whatsoever arising out of any injury, damage or loss which may be sustainded druing the course.*

I agreeI do not agree
CONSENT IN CASE OF DEATH: In the event of accidental death, I agree that Youth With A Mission will make every effort to meet the bureaucratic needs of your family related to the transportation of the body in accordance with current laws and diplomatic agreements between Brazil and your country and to the extent possible, excluding any mandatory liability.*

I agreeI do not agree
TREATMENT CONSENT: I agree to allow any medical treatment, operations, anesthesia according to medical opinion and specific need.*

I agreeI do not agree
IMAGE USE RIGHT: I authorize the use of my image in any and all photos, videos, documents, home page, posters, electronic media, among others, to be released by YWAM Recife. I declare that I authorize the use described above without anything being claimed as related rights to my image or any others.*

I agreeI do not agree
REFERENCE FORMS

Enter the names and email addresses of the two people who will respond to the confidential forms.
Pastor's name*

First Name Last name
Pastor's email*
example@example.com
Leader name *

First Name Last Name
Leader email *
example@example.com
I CERTIFY THAT ALL INFORMATION IN THIS APPLICATION IS COMPLETE AND ACCURATE. IF ACCEPTED BY YOUTH WITH A MISSION, I WILL ABIDE BY THE SPIRIT, RULES, AND SCHEDULE OF THE PROGRAM. I CONFIRM THAT I UNDERSTAND THAT PAYMENT OF THE REQUIRED SCHOOL FEES MUST BE MADE UPON OR BEFORE ARRIVAL. I ALSO CONFIRM THAT I AM FULLY AWARE OF MY FINANCIAL OBLIGATIONS, BOTH TO THE LORD AND TO THE STUDENTS AND STAFF AT THE SCHOOL. I THEREFORE COMMIT MYSELF TO PAYING ALL PERSONAL EXPENSES INCURRED DURING MY INVOLVEMENT WITH YOUTH WITH A MISSION.

Clear
Should be Empty:

CHILDREN AT RISK APPLICATION

PERSONAL INFORMATION:

HOME CHURCH

IN CASE OF EMERGENCY CONTACT:

SCHOOL EDUCATION/EMPLOYMENT/SKILLS

YWAM experience

Questions

PERSONAL INFORMATION

PERSONAL HEALTH HISTORY:

REFERENCE FORMS