Name: 

Address:

Telephone:              Email:

Name and Address of Church: 

Age?           16/17         18-20         21-24         25+

Please give name and address of 2 Referees (one must be your church minister):

Name 1:       Address 1:        

Name 2:       Address 2:

Please indicate which week(s) you will be available:

Sat 1st July 2000                                           Sat 8th July 2000      

Sat 15th July 2000                                         Sat 22nd July 2000

Sat 29th July 2000                                         Sat 5th August 2000 

Not sure yet.

Please indicate which group you would prefer to work with:

1st choice Junior Mixed Senior Boys Senior Girls -Please select- Any   2nd choice -No more- Junior Mixed Senior Boys Senior Girls   3rd Choice -No more- Junior Mixed Senior Boys Senior Girls

Do you hold a current driving license? no yes

Would you be happy to drive a minibus (25 years + only) not applicable yes no

Please list any first aid or life saving qualifications you hold:

Please list any previous youth work experience you have:

Please indicate which of the following activities you would be able to lead or participate in - this is not a place for modesty!!!!!!

Outdoor Sports participate lead not my scene         Indoor Sports participate lead not my scene       Water Sports participate lead not my scene

Board Games   participate lead not my scene         Silly Games!  participate lead not my scene         Crafts         participate lead not my scene

Music participate lead not my scene   Instrument(s) played

                                                                            (- please bring with you if appropriate)

Cooking willing to help willing to take on only if you don`t mind BBQ cornflakes!!!!

Any other activities you fancy?

Any other comments?