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British Pilgrimage of Hope (15-26 July 2013)
Please complete the form in as much detail as possible. We will be sending you a welcome pack with full details of travel arrangements, where you will be staying, what you need to bring and so on nearer the time. If you are under 18 we also require a reference from a church leader or youth group leader to be sent to: pilgrimage@fusionyac.org


Personal Details

First Name *
Surname *
Address1 *
Address2
Town *
County
Post Code *
Country *
Age *
Email *
Home Tel
Mobile
Emergency contact name *
Emergency contact Tel No. *
Emergency contact email *


Medical Information

Any dietary requirements?
Are you taking any regular or prescribed medication? If so please name the medication
Do you have any existing medical conditions for our first aid team to know about so we can care for you more effectively?
Is there anything about your health that means you can only engage in limited physical activity? Please give details
Is there any other information that may help us care for you? If yes please give details
Have you undergone significant surgery in the last 3 years? If yes please give details.
Date of last tetanus injection
Do you have any known allergies? * If yes please fill in the Allergic Reaction Management form available for download on the Pilgramge website. *
Do you have Asthma? *
Your Doctor's Name *
Your Doctor's Tel. No. (inc national and local code) *


History and References
Please give the name and contact details of a Fusion Staff memeber or responsible adult who knows you well and would be available to contact as a referee. Please note they should not be related to you.
In your own words, please describe why you would like to be part of the British Pilgrimage
Referee Name *
Referee Email
Referee Tel No *
Are they Fusion Staff?
Name of Church you attend (if applicable)
What role if any do you play in the church? (if applicable)
Minister / Pastors Name (if applicable)
Your Minister's Email (if applicable)
Minister's Tel No (if applicable)
Other Christian or life experiences that may be helpful for us to know in considering your application (e.g. volunteer work, particular skills etc)
Have you completed Fusion's Foundation's course before?


Skills
FESTIVAL SKILLS - If you have any experience of the following skills then please tick all that apply:


Other skills eg can play an instrument
T-Shirt Size *

Finances
I understand that a £60 (70Euros, 97AUD) deposit is required by the 1st June 2012 and will forward a cheque payable to 'Fusion Youth & Community UK' to Fusion YAC UK, St. Mary's Centre, Haddenham, Bucks, HP17 8AJ
£60 Deposit
Payment options *


The Small Print
I understand there will be Christian content and am happy with this
I would like to talk to a leader about this
I give permission for photos and videos of me to be used for future Fusion YAC UK publications and promotions
I accept that Fusion and its leaders or helpers, can accept no liability for any personal injury or property loss suffered by myself during the program *
I will abide by Fusion's norms & values on the trip which include Respect, Safety, Participation and Nothing Illegal


Travel Information
Please indicate below if you know how you will be arriving at the start of the Pilgrimage. We would encourage international travelers (especially long haul) to arrive on the 21st July. We will be sending you a form to complete for more information (e.g. flight details etc)
Travel Arrangements *
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Fusion Youth and Community UK | Registered Charity #1112078 |St Mary’s Centre, Haddenham, Bucks, HP17 8AJ