The Application Form February 12, 2011March 27, 2018 Theo If you would like to apply, please complete the following form: Application Form - Impact Training * indicates required field Name:* General Information Course* Spring 2019 Fall 2019 Gender* Male Female Age at start of course* Marital status Email* Telephone (inc country and area code) Address Emergency Contact Emergency contact name Emergency contact e-mail Emergency contact telephone no. Relationship to applicant Personal Profile Level of training / education completed Work experience Skills / interests / hobbies / sport involvements Temperament tendencies Introverted / extroverted 1 - Introverted 2 3 4 5 - Extroverted People oriented / task oriented 1 - People oriented 2 3 4 5 - Task oriented Which best describes you? Takes charge and get things done Easy going ready to assist others Likes details wants to consider all options first Enjoys lots of people around How would others characterize you? Do you prefer to work alone or with others? Do you live with your family? Before leaving home in the morning would you have made your bed and tidied your room? Are you actively involved in your local church? How? Are you born again of the Spirit of God? How do you know this? How would you describe your Christian walk? Please give a comprehensive explanation of why you want to participate in our program and what you believe may be your contribution to the team and in what areas you would like others to help you. Health Do you suffer from any disability that would limit you doing practical duties? Have you had a nervous or mental illness at any time? Have you suffered from and had treatment for anorexia nervosa or bulimia? Do you suffer from any allergies? Do you have diabetes, epilepsy, blackouts or other medical problems? Do you require any regular prescribed medication? Do you require a special diet for medical reasons? Do you have a learning disability? If you answered yes to any of these health questions, please provide full details here Conditions of EnrolmentIn applying for this program you pledge to apply yourself wholeheartedly: To crew the ship, assisting in sailing, mooring, domestic & maintenance work To participate in all aspects of the training program, including the satisfactory completion of assignments and participation in outreaches To attend the whole course from beginning to end. No refunds will be given for early departure To dress modestly, and generally be clean and tidy responding positively to directives of the leadership team as relates to appropriate conduct in our environment and culture To abstain from smoking, consuming alcohol and illicit drugs To financially compensate for any damages caused to property or persons that you may have caused To fully comply with any directives given by the skipper and leadership team We reserve the right to terminate the participation of any person who does not satisfactorily comply and the balance of the fees will be forfeited. Enrolment Agreement I am 18 years of age or over, have read and understood the conditions of enrolment and am prepared to fully comply as directed in all matter. I accept these terms and conditions* CAPTCHA Code:* Powered by Fast Secure Contact Form