Youth Leadership Training Application 2022

Thank you for taking this opportunity to attend a Youth Leadership Training program.

Next Training Program

Dates
December 22 - December 25, 2022

Venue
Bethshan Camp & Conference Centre
70 Wyee Rd, Wyee NSW 2259

Please note: attending Youth Leadership Training is necessary preparation, but does not guarantee a place for you as youth leader at Music Camp.

Please Upload or Take a Recent Photo of Yourself *

Firstname *

Date of Birth *

Address *

City *

State *

Postcode *

Lastname *

Gender *

Email *

Phone / Mobile *

Year Baptised *

Your Home Church *

Relationship Status *

Current Occupation / Grade in School *

I support the mission, teachings and evangelism of the Seventh-day Adventist Church. *

I would be interested in attending Music Camp or D'Sozo Camp as a Counsellor *

Alternative / Emergency Contact

Name *

Mobile Phone *

Relation to You *

Home Phone

Work Phone

Medical

Tick any medical history that applies to you. All answers will be held in strict confidence.

Other medical history

Allergies

Please provide details of allergies

Do you have private health insurance?

Health Insurance Details

Misc.

Have you ever been arrested, convicted or investigated for a crime involving drugs, sex or violence? *

Do you hold a current First Aid Certificate?

Do you hold a suitability card for child-related employment? (e.g. Working With Children Check) *

Working With Children Check Number:

Financial

Optional Donation $ (expenses may be higher than actual fees charged)

Please choose the payment method that applies

Please send bank deposits to:

Account Name:	Madison Missions
Bank:	Commonwealth
BSB:	063 689
Account Number:	1028 0545

The information I have entered is true and correct to the best of my knowledge. *

Submit Application