ROMANIA PROJECT 2004

in association with

the Romanian

Cristia Association

Application Form to join as a Camp/Holiday Club Leader

to be sent as soon as possible, at the latest by 3 May 2004

Surname

Forename.

Home Address(incl. postcode):

Tel (incl. code):

Age on 5/07/2004:

Mobile tel (if applicable): ……………………….

E-mail address:

Term time address (if applicable) incl postcode:

Term time tel:

Term Dates:

Term time e-mail address (if applicable):

How many weeks would you like to spend in Romania?

Full range of dates when available (we will confirm most suitable):

Current Occupation:

Current Church:

Involvement with Crusaders or other Christian youth work:

Camp/Holiday Club Experience:

Any special gifts/experience that you could use - please give details:

Leadership Experience:

Reasons for your application:

Give details if you are under regular medication, or suffering from any chronic illness

(consult your doctor if you are unsure):

Referees:

Leader in your church/Crusader/other Christian Group who supports your application:

Surname Forename:

Address (incl. postcode):

Tel (incl. code): ……………………………………

Mobile tel:

Additional person who knows you well at work/college who would give a reference:

Surname Forename.

Address (incl. postcode):

Tel (incl. code):

Mobile tel:

Declaration: I declare that I have not been convicted or cautioned for, or am under

investigation for, any offence other than motoring offences. (This position is exempt

from the Rehabilitation of Offenders Act 1974)

Signed:

(If unable to sign this, please give details separately in confidence)

o I would like to apply to join a camp/holiday club in Romania

o I am available to attend the preparation weekend 18 – 20 June

Signed:

Date:

Please send completed Application Form by 3 May to:

David Moffoot, 30 Seaton Road, Smithills, Bolton. BL1 6JB

 

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