2024 - Team Volunteer Form - Chrysalis
This form has to be completed by all team members volunteering for the 2024 Flights.
This form includes the, Declaration, Indemnity, permission to do Police Clearance as well as POPI permissions.
Team fees to be paid into the following account: Gloriosa Emmaus Community, First National Bank; Acc #: 551 5003 4996 Branch code: 252145 (Hatfield); Reference: Name, Surname & Walk#.
Flight dates: Boys flight #67 and Girls flight #68 - 4 to 7 July 2024
Team Selection Date: 14 May
Training dates: 1, 21 and 22 June
Venue for training: Valley Methodist Church
Fees: R990.00
Please share a copy of your ID by emailing it to registrar@gloriosa.emsa.org.za - Cost R270 not part of team fee.

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DECLARATION:
1. I volunteer to serve Christ on Chrysalis & submit this volunteer form for the process of team selection.
2. I will attend all the TFs. I am aware that my attendance of these events is necessary & secures me as part of the team
3. I commit to participating in prayer for the Caterpillars & team & to serve for the entire Emmaus Walk - from my arrival at 13:00 on the Thursday to ending at 18H00 on the Sunday after clean-up
 *
Surname *
Name *
Date of Birth *
ID Number *
Flight number *
Address *
Cell number *
Email address *
Church you attend *
Clergy Name and Surname *
Clergy Cell number
 *
Clergy Email Address
 *
Angels date and times
Indicate in which portfolio you have served on a Flight or Walk *
Required
Indicate which talks you have given on a Flight, Encounter or Walk 
 *
If under 18 - Parent / Guardian name *
If under 18 - Parent / Guardian Cell *
Medical - Special requirements *
Special needs for sleeping *
Diet - Special requirements *
Contact person 1 in case of Emergency. Provide name and Cell number *
Contact person 2 in case of Emergency. Provide name and Cell number *
POPI act: As per the POPI act we require all Pilgrim’s/Participant’s permission to send him/her community information and other communications. Our newsletter is not compulsory but would benefit you as it contains information about Emmaus events and prayer requests. Emmaus declares that your information will not be distributed or used outside the Emmaus Ministries environment. *
Required
Police Clearance Certificate Application:
Permission To work on Chrysalis you are required to furnish us with a Police Clearance Certificate which confirms you have not been found unsuitable to work with children / minors in terms of Sections 120 to 123 of the Children’s Act 38 of 2005 (or any amendments thereto). 

I agree that Gloriosa Emmaus Community / Chrysalis Management may send a written request to the SAPS for Police Clearance Certificate in respect of myself. 

I also agree that I am liable for the costs thereof and that I will sign all required documents and provide the Gloriosa Emmaus Community / Chrysalis Management with all information and documents necessary to enable them to apply for the Police Clearance Certificate on my behalf  
 *
Indemnity:
In consideration of the Emmaus Gloriosa Community:
• I hereby release and indemnify the Emmaus Gloriosa Community, its officers, leaders, agents and members against any liability (including negligence) in relation to participation in any activity connected with the aforementioned, or when travelling to and from such activity.
• I authorize the Emmaus Gloriosa Community, in the event of any injury or illness occurring in connection with any activity connected with the Emmaus Gloriosa Community, to obtain on my behalf and at my expense any medical treatment as may be considered appropriate by them. I agree to pay all costs associated with such injury or illness. *
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