Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

Country

(###)

###

####

Do you have a spouse coming with you? *

Yes

No

Spouse Name

First Name

Last Name

Do you have any children coming you with you? *

Yes

No

Contact Name

First Name

Last Name

Date Of Issue *

MM

DD

YYYY

Date of Expiry *

MM

DD

YYYY

Do you currently have family in Japan *

Yes

No

Do you have a criminal record? *

Yes

No

Do you have food allergies? *

Yes

No

Do you have any other allergies? (eg: drugs, medication) *

Yes

No

Do you have any issues regarding sleep that requires attention? *

Yes

No

Are you presently under doctor care? *

Yes

No

Are you presently taking any medication?

Yes

No

Do you have any physical impairments, handicaps or health conditions which require special attention? *

Yes

No

Are you currently experiencing any mental health issues? *

Yes

No

Financial Responsibility Agreement *

I accept all responsibility for any YWAM fees, state obligations and personal expenses incurred during my involvement with Youth With A Mission.

Release Liability Agreement *

I/we, do hereby release Youth With A Mission, its agents, employees, and volunteer assistants from any liability whatsoever arising out of injury, damage, or loss, which may be sustained by said person during the course of involvement with Youth With A Mission. (If applicant is under 20 years of age, a physical copy of the signature of parent or responsible party is required. After submitting this application, you will receive more instructions via email.)

I agree to the Release Liability Agreement

Consent for Treatment

As a prospective staff for Youth With A Mission, I realise that God may call me to work in a situation or country that may be dangerous or lacking in medical facilities. Should the need arise, where I am either sick or injured and urgently require medical attention, I willingly give to Youth With A Mission and its leaders the authority to make any decision concerning my immediate treatment that they prayerfully consider to be in my best interests, until such a time as I am able to make decisions for myself. (If applicant is under 20 years of age, a physical copy of the signature of parent or responsible party is required. After submitting this application, you will receive more instructions via email.)

I agree to Consent for Treatment

In Case of Death *

Please agree to one of the following two agreements in case of your death overseas:

1. I hereby give consent to Youth With A Mission, its agents, employees, or voluntary assistants to arrange for my body to be buried, cremated (whichever is the most customarily suitable in the country of my death) in the event of death overseas.

2. I hereby declare that in the event of my death overseas, it is my request that my body be returned to my home country at the expense of my estate. I nominate as the executor of my will:

Executor's Name

First Name

Last Name

Executor's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Final Agreement *

I have truthfully completed all portions of this application for admissions to the staff position for which I am applying. If I am accepted into Youth With A Mission, I will abide by the spirit, rules, and schedule of YWAM Tokyo