SERVE Application 2019
Connor Diocese are running the SERVE Programme, developed by Tim Burns for Down and Dromore Diocese. The course will be delivered by Rev Philip Benson and Christina Baillie for young people aged 15 to 19. The course will be run for those exploring leadership in their local parish context.

SERVE will include 8 sessions as well as an opportunity to serve in a Diocesan event and the Graduation. The eight sessions will run weekly from 17th September to 12th November with a break for half term, on Tuesday evenings from 6pm to 9pm in The Hub Chaplaincy, Elmwood Avenue, Belfast.  

To participate in SERVE it costs £50 per participant, to cover dinner each week, handbook, sweatshirt as well as graduation ceremony and certificate.

The SERVE Graduation will take place on Tuesday 19th November from 7.30pm for participants to attend with friends, family, leaders and clergy.
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Name *
Age *
Date of Birth *
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Address and Postcode *
Phone Number *
Email *
Parish
Clergy Name:
Describe your relationship with God? How are you involved in your church? What things do you do to keep your relationship with God growing? *
Describe Yourself: Are you quiet or like to talk, what things do you like to do, your favourite subjects, films, sport…? *
Leadership Experience: Where have you had the opportunity to lead, maybe it is in a sports team, or leading a discussion in class or maybe taking a lead with your friends on somewhere to go or something to do… what was good, what was difficult? *
What leaders have influenced you? How? *
Medical and Dietary Information (To be completed by Parent/Guardian if under 18) Please supply any medical information about you that we should be aware of (allergies, asthma, diabetes, epilepsy etc): *
If over 18, please provide details of next of kin, Name:
If over 18, please provide details of next of kin, Mobile number:
Doctor Name:
Doctor's Address
Doctor's Mobile Number
REFEREES: Please provide details of two people who would be willing to provide a reference for you. Please ensure you ask permission before you put their name down and one referee must be your minister or church leader.
Referee's Name #1 *
Referee's Position *
Referee's Email Address *
Referee's Number: *
Referee's Name #2 *
Referee's Email Address *
Referee's Number: *
COMMITMENT. I understand that participation on this course means that: I will ensure that I can attend the 8 weekly sessions in Church House. I will commit to reading the recommended book. I agree to participate fully in all the activities, discussion and learning, and beyond that to focus on relationship building with the other participants. *
PARENTAL CONSENT IF UNDER 18. I confirm that I have given my consent for my son/daughter to participate on the SERVE Developing leaders course. In the event of my son/daughter being taken ill or injured during the period of the event so that a surgical operation or serum injection becomes necessary, I hereby authorise the leader in charge to sign on my behalf any written form of consent required, provided that the delay necessitated to obtain my permission might endanger my son’s/ daughter’s health or safety. I also give permission for my child to receive necessary first aid or treatment deemed necessary.
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I permit my image/my child’s image to be taken and used in Diocesan promotion, online, printed and on social media. *
Signed by Parent/Guardian (By writing your name here, you are giving consent for your child to take part in SERVE and that all information above is correct)
Parent/Guardian Name and Mobile number:
Parent/Guardian Email Address:
By confirming below, you are agreeing to consent to Connor Diocese holding and processing your personal data for the purposes of contacting you about SERVE, planning and administration for the event. *
For more information regarding SERVE contact the Diocesan Youth Officer, Christina Baillie on 07753312405. On receipt of your application we will write back to you to confirm your position on SERVE and with further details regarding the course. Closing date for applications is Tuesday 10th September 2019.
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