Young Leader & {Disciple} Form

To be completed by every Young Leader (16-21) and every {Disciple} Student

Young Leader & {Disciple} form

Please take a moment to fill out the form.

Full Name, Address, Email, Phone Number, Occupation (e.g. Student)

Date of Birth

Name of Parent/Guardian (who will also act as Emergency Contact), Address, Email, Phone Number

Church Name, Name of Church Leader, Email Address of Church Leader or Office

ABOUT YOU. Please tell us about your experience of Church and being a Christian

Tell us about your passions, hobbies, interests, AND anything you want to be involved in as a Young Leader at Impact (e.g. actvities, sports, tech (PA/AV), music, drama, speaking, crafts. Helping with catering, logistics, administration...?)

MENTOR. If you are taking part in the {Disciple} Programme, as well as the Impact Weekend we encourage all our students to have a local mentor. Please give us the NAME and CONTACT DETAILS of someone who could act as your mentor. (We will contact your church leader and your mentor about this role. Please speak to them before submitting this form. If you are unsure about this, leave blank for now).

REFERENCE. Please give us details of TWO people who we could ask for a reference for your suitability to serve as a Young Leader on the Impact Weekend. (These people can include your church leader and/or mentor). Referee's Name, Phone, and Email Address

Please check all boxes that apply

I wish to be a Young Leader at the Impact Youth Weekend (October)

I wish to be a part of the {Disciple} Programme

I wish to take part in the {Disciple} Adventure Weekend (July)

Declarations

I confirm that the above information is correct and up to date

I am over 18, or I am under 18 and have consent from parent/guardians to participate in these NWBA activities (NB: parents/guardians will also contacted in relation to your application form)

I have/will now complete the Health Form

Thanks for submitting!

Click here to go to the Health Form

Data Protection Statement

Under Data Protection legislation the Charity Trustees of the North Western Baptist Association are the Data Controller and can be contacted by ringing 01942 221595or emailing dataprotection@nwba.org.uk

We are collecting this information to enable the NWBA to run the {Disciple} Programme safely and ensure we can contact you in case of an emergency.

Data Protection legislation allows us to process this information as we regard it as being in the Association’s legitimate interest. If you are unable to supply the information requested then we will be unable to accept your application to attend the weekend.

The information you supply will be held electronically on the Association Sharepoint and Impact email inbox which is password protected and accessed only by the NWBA Team. Information will also be stored in paper form in a folder which will be kept in a securely locked cupboard in an Association office. This information may be shared with the Impact Team as appropriate for the sole purpose of running this event.

We will destroy data in accordance with NWBA’s Data Retention Policy. Safeguarding information such as records of DBS clearance will be retained for 75 years according to our Data Retention Policy. We will NOT pass on this information to anyone else.

If you are concerned about the way your information is being handled please speak to our Data Protection Trustee. If you are still unhappy you have the right to complain to the Information Commissioners Office.