Application form for 2002

ROMANIA PROJECT 2002

in association with

the Romanian

Cristia Foundation

Application Form to join as a Camp/Holiday Club Leader

to be sent as soon as possible, at the latest by 20 May 2002

Surname.................................................................. Forename:...................................................

Home address (inc. postcode).......................................................................................................

……………………………………........................... …………………………………………………

Tel (incl. code)............................ ………..........………………… Age on 8/07/2002:.............

E-mail address (if applicable):........................................................................................................

Term time (if applicable) address + postcode:............................................................................

................................................................................... ………...............................................................

Term time tel(incl.code):……..........................…. Mobile tel:.....................……........................

Term dates:………………………………………………………………………….……………….

Term time e-mail address (if applicable):.....................................................................................

Number of weeks you would like to spend in Romania:............................................................

Please give 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 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 are suffering from any chronic illness

(please consult your doctor if you are unsure):............................................................................

...............................................................................................................................................................

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

Surname...................................................................... Forename:..................................................

Address:...............................................................................................................................................

Postcode: .................................................................... Tel (incl. code):...........................................

Additional person to whom you are well known at work/college who would give a reference:

Surname (& title)......................................................... Forename:..................................................

Address:...............................................................................................................................................

Postcode: .................................................................... Tel (incl. code):...........................................

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)

Application:

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

o I am available to attend the preparation weekend 28 – 30 June

Signed:.................................................................................................................................................................

Date:.....................................................................................................................................................

Please send completed application forms as soon as possible and no later than 20 May 2002.

Please contact David Moffoot ( d.moffoot@lineone.net ) for the postal address for completed forms.