Come Visit
Please fill out this form if you are planning to come volunteer or stay for a short amount of time. 
Sign in to Google to save your progress. Learn more
Name *
Email *
Phone Number (Please include country code) *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Country of Citizenship *
Language *
Preferred Language of Communication *
What dates would you like to visit? *
Additional Information
Marital Status *
If married, will your spouse be joining you?
Clear selection
Please list the names / ages / gender of any others accompanying you:
Do you have any allergies we should know about? *
If leading a team, does anyone on your team have allergies we should know about?
Emergency Contact Information
Person we can contact if there's an emergency.
Name of Emergency Contact *
Relationship to Emergency Contact *
Emergency Contact's Phone Number *
Emergency Contact's Email *
Waiver and Release of Liability 
I do hereby release Youth With A Mission, its agents, employees and volunteer assistance from any liability whatsoever arising out of any injury, damage or loss which may be sustained by myself or other persons during my course of involvement with Youth With A Mission.
 *
Required
I am aware that there is a pool on sight, if minors are accompanying me, I agree to supervise them and their use of the pool.
 *
Required
I give YWAM Durban permission to use photos and videos that may contain me on their social media/website.
 *
Required
I take full responsibility and agree to pay for all expenses incurred during my stay at Youth With A Mission Durban. 
 *
Required
Consent for Treatment 

In the event of an emergency in which I am rendered unconscious and my nearest responsible relative, guardian, emergency contact cannot be contacted, I hereby agree to such treatment, anesthetics and operations to be performed upon myself as in the opinion of the attending physician(s) is deemed necessary.
 *
Required
Declaration

I declare that all information that I have supplied in my application is true, accurate and complete to the best of my knowledge.
 *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of YWAM Durban. Report Abuse
Google Forms