Building Discipleship Course Application Form

Which BDC option are you applying for?*

Full Time including accommodation and food (NZ$1,800

Full Time living off-site locally (NZ$1,100)

First name*

Last name*

Phone number*

Email*

Street address*

City*

State/Region*

Country/Region*

Nationality as shown on passport*

Gender*

Date of birth*

Please upload a photo of yourself*

Marital Status*

Will any dependents be joining you?

yes

Education

Highest school or university/college completed*

What is your home language?*

List any other languages you speak?

If English is your second language, please rate your abilities below:

Speaking

Understanding spoken English

Writing

Reading

Do you have finances to pay for this school?

Please tick*

yes

Emergency information - who should we contact in case of emergency?*

Is there a domestic situation that might make it necessary for you to return home?*

Why do you want to do this Course?*

Do you smoke and/or drink alcohol?*

yes

If answered yes to the above please comment on how often

Please add any other relevant information concerning medical, psychological, addiction or any other areas of your life you want us to know more about to be of service to you

Do you have any food allergies or dietary requirements?*

Please provide the name, email and phone number for 2 references below, indicating their relation to you in a few words.

Reference 1*

Reference 2*

Disclaimer
Consent for treatment
Should a situation arise where I am sick or injured and urgently require medical attention, I give to the base director, or his or her delegate the authority to make any decision concerning my immediate treatment, including anaesthetics, medication and operations as in the opinion of the attending physician, are deemed necessary or until such time as I am able to make the next decisions for myself. I declare that the above named shall not be required to contact my next of kin prior to exercising his/her authority as provided herein.

I declare that I shall not hold Youth With A Mission, the base director or his/her delegate, liable for any decision made by him/her for any damage or loss that I sustain as a result of exercising the authority herein granted by me.*

Liability Release - ''I release Youth With A Mission, it's agents, employees and volunteer workers from any liability whatsoever arising out of injury, damage or loss which may be sustained by myself during the course of my involvement with Youth With A Mission"*

Acknowledgement of Financial Responsibility and School/Base Accountability - I understand that payment of the required course fees must be made upon my arrival for the course, unless otherwise approved in writing by the course director. All other applicable fees, if any, must be paid in total by midway through the lecture phase. I also understand that I am fully responsible for meeting the cost of any medical treatment that I may require during my involvement with YWAM Nelson NZ. I confirm my agreement to abide by all base rules, policies and procedures and follow all reasonable instructions and Health & Safety requirements.*

Burial Statement "In case of my death during the course of my involvement with Youth With A Mission, I wish that my next of kin be advised as soon as practical and that their wishes with regard to funeral and disposal of my body be complied with so long as my next of kin places Youth With A Mission in sufficient funds to carry out those wishes. In the case where Youth With A Mission is unable to contact my next of kin, or that my next of kin are unable or unwilling to give directions with regard to funeral and disposal of my body and come to a satisfactory arrangement with regard to payment of related costs within reasonable time, then I direct that Youth With A Mission at its sole discretion make arrangements for funeral and disposal (including burial in a foreign country) at the expense of my estate. "*