Disciple Application

To apply to be a member of the Discipleship Team for Youth Summit 2010, please fill out this form and click "Next" to continue.

For assistance, please contact registration@youthsummit.ca.

Personal Information

Please complete this information in full.

Title
Full name
Address
City
Province
Postal Code
Phone # (home)
Phone # (cellular)
Phone # (business)
Email Address
Group	If you are coming with a formally organized group, please indicate the group's name.
Sex	malefemale
Date of Birth
Healthcard Number
Language Preferred	EnglishFrench
Translation Required	yes
Vocation Information
Affiliation / More Information

Emergency Contact Information

Please provide information on someone we can contact in the event of an emergency.

Full name
Relationship	The relationship the emergency contact has with you.
Address
City
Province
Postal Code
Phone # (home)
Phone # (cellular)
Phone # (business)

Special Needs

Please check all that apply and describe how we can meet your special needs in the space provided.

Handicap	Yes, details indicated below
Health	Yes, details indicated below
Diet	Yes, details indicated below
Accommodations	Yes, details indicated below
Allergies (including pets)	Yes, details indicated below
Other	Yes, details indicated below
Details / More Information

Skills Inventory

Please check all that apply, and elaborate where space is provided.

Musical Ability

Voice

Sing	yes
Professional	(Opera, Country, R&B, Rap, Children's Music, Praise & Worship, or other - please specify) yes
Other

Keyboard

Play a keyboard instrument	yes
Concert Pianist	yes
Grade level
Many years of lessons	yes
Play by ear	yes
Have played for group Praise & Worship	yes
Other experience

Guitar

Other

Play other musical instrument

Performing Arts

Acting Experience
Drama / Skits
Backstage / Props
Dance
Clowning	yes
Mime	yes
Magic Tricks	yes
Gymnastics	(Cartwheels, Back-flips, etc.) yes
Other

Artistic Ability

Paint	yes
Draw

Technical Experience

Sound System	yes
Projector	yes
Computer
Other

Group Work

Lead small groups	yes
Group participant	yes
Youth
Adult

Public Speaking Experience

Testimony

A testimony is your story: sharing your faith journey in 3 - 5 minutes

Have never shared	yes
Do not feel that I have one	yes
Shared one-on-one	yes
Shared with small group (3-10 people)	yes
Shared with large group (11-50 people)	yes
Other

Hobbies and Interests

Personality

Place yourself on each continuum below by circling numbers you are closest to for each area.

Language

Languages you speak

English	yes
French	yes
Other

First Aid

CPR Level
Standard First Aid	yes
EMT	yes
Other

Other

Degree, Certification and other educational experience
In addition to the health concerns you have already listed, are there any which may cause you problems working on the project (e.g. tiredness, reactions to heat, etc.)?
Have you ever been convicted of a criminal offence for which you have not been granted a pardon? yes
Is there any reason that you would be uncomfortable with, or unable to work with high school aged youth? yes

Short Answer Questions

Describe yourself: what are you presently doing (working, university student, what are you studying at school, etc.), your interests and hobbies.
Why do you want to be a volunteer with Youth Summit 2010? Please include specific goals and objectives.
Describe your faith journey and who Jesus is in your life. Would you say that you know Jesus in a personal way? Describe your spiritual life, including when and how you pray, the sacraments, and what spiritual resources you may be using.
Are you willing to participate in group prayer, worship times, scripture study, and personal daily prayer times? Please comment.
Describe any leadership experiences you have (e.g. leading small groups, organizations, etc.) Describe any music, drama, or speaking skills and experiences you have.
Any other comments you would like to include.

For assistance, please contact registration@youthsummit.ca.

For more information, contact | Pour plus d’information, contacter

monteejeunesse@archottawa.ca | 613.738.5025 x229

Play guitar	yes
Beginner	yes
Can read music	yes
Number of years playing
Play by ear	yes
Have played for group Praise & Worship	yes
Other experience