Disciples 25/26 Sign Up

Disciples 25/26 Application Form

DISCIPLES is an Exodus programme that helps those in year 11+ follow Jesus. It offers fun, challenge and support from September to March and includes monthly gatherings, pods (with a mentor and peers) and a residential. The cost of £35 is paid at the end of the form. It goes towards a journal & materials & costs for the gatherings but the residential will be an extra cost.
Personal Details
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Disciples must be in Year 11+
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

The DISCIPLES Programme
In Which Area Would you Like to Sign Up for DISCIPLES?*
What Do You Hope to Gain by Being Part of DISCIPLES?*
DISCIPLES is for those aged 15-25 who want to be equipped to follow Jesus and live consistent, faith-filled lives.
How Did You Hear about DISCIPLES? (You can tick more than one!)*

From a FriendExodus visited my schoolExodus visited my churchSocial MediaEmailOn An Exodus TeamI've been part of DISCIPLES before

Engagement
School/University/College (if applicable)
Optional: This information helps us understand how well we are engaging with different schools/universities/colleges in each area.
Church (if applicable)
Optional: This information helps us understand how well we are engaging with different churches in each area.

Allergies, Dietary Requirements & Medical
Do you have any allergies?*

YesNo
If You Answered Yes - please indicate how severe your allergy is*

MildMediumSevere
Please list below the allergies you have, and if any, recommended actions to take*
Do you have any medical conditions?*

YesNo
Please list any medical conditions, either mild or serious; and list any medication you are taking that Exodus leaders should be aware of.*
What Advice would you give Exodus leaders to help support you with your condition? *
Have You Been Issued with an Epipen?*

YesNo
Please List Any Dietary Requirements below*

Parental Consent/Next of Kin
Name of Parent/Guardian*

First NameLast Name
For those under 18, a request for a parental/guardian consent form will be sent to this person. And these details will be used in the case of an emergency.
What is this Persons Relationship to You?*
Address of Parent/Guardian*

Street Address

Street Address Line 2

CityCounty

Post Code
Phone Number of Parent/Guardian*
Please enter a valid phone number. This MUST NOT be your own mobile number.
Email of Parent/Guardian*
example@example.com
Alternative Emergency Contact Name*

First NameLast Name
Alternative Contact Phone Number*
Please enter a valid phone number. This MUST NOT be your own mobile number.

Payments & Permissions
Please Tick One Below*

I give permission for Exodus to use photos/videos of me on social media or for other promotional purposes.I DO NOT give permission for Exodus to use photos/videos of me on social media or for other promotional purposes.
Please Tick One Below*

I give permission for Exodus to contact me for about other opportunities in the futureI DO NOT give permission for Exodus to contact me for about other opportunities in the future
We want to make the DISCIPLES programme as accessible as possible. If you are struggling to pay for the programme and require financial assistance, please get in touch via info@exodusonline.org.uk to inquire about a bursary.

Disciples 25/26 Payment

Disciples Payment 25/26This payment of £35 goes towards the programme costs, catering and a Disciples Journal.

£35.00 QuantityDISCIPLES Area

Total

£0.00

Disciples 25/26 Application Form