Response Pastor - Application Form

1. Introduction S M L XL XXL Response Pastor Tabard Size required:

Are you involved in any form of ministry in your church or in some other Christian organisation, e.g. Children/Youth work, Teaching, Leading Worship, Administration, Community Work, Hospitality, etc. If Yes, please state clearly what this involves:

Please state your reasons for wanting to be a Response Pastor:

What are your expectations from the Response Pastor’s deployment as part of the team?

2. Your Skills

Do you have an up-to-date First Aid Certificate? Yes No

Do you possess any other skills, which may be useful as a Response Pastor?

Response Pastor Application Form – Dec 2015 1 | P a g e 3. Your Health Do you suffer from any medical condition we need to be aware of? Yes No

Are you currently on any medication? If so, please give details: Yes No

Are you subject to any dietary restrictions? Yes No

4. Emergency Contact

Emergency details 1 Name: Home No.

Relationship Mobile No.

Address

DECLARATION: I confirm that I have signed the volunteer’s agreement; completed a confidential self declaration form and have a ID card and current DBS (within last 3 years). To the best of my knowledge the information given in this application form is true and correct.

Signature: ______Date: ______

______

______Payment information: to order Uniform [cap & tabard], Admin/handbook/refreshments & Optional handy Response Pastor shoulder bag

Via your area Co-ordinator

Response Pastor Application Form – Dec 2015 2 | P a g e Please Return Completed Application Form to Response Pastors to your co-ordinator (either post in or for- ward as attachment via email for information to: [email protected]. Please tick □ if you do not wish to receive updates and communications from AT

Response Pastor Training attended (date): or will be attended on:

Any additional information:

Response Pastor Application Form – Dec 2015 3 | P a g e