Student Application

Lead Source

First Name*

Last Name*

Date of Birth*

Gender*

Male Female

Country of Citizenship*

The country of the passport you will travel on

Please upload a recent photo:* No File Chosen

File uploads may not work on some mobile devices.

Email*

Phone Country Code*

Phone*

Address*

Address Line 1

City

State/Province

ZIP / Postal

Country

Marital Status*

Spouse Name*

First Name

Last Name

Spouse Email*

Number of Children*

Children's ages

Location you are applying to*

Course Type*

DTS Year*

DTS Quarter*

DTS Theme January*

DTS Theme - April*

DTS Theme - July*

DTS Theme - September*

DTS Theme September Liberty*

DTS Theme September Pisa*

DTS Theme September Panamá

Course Year*

Course Quarter*

Course Theme January*

Course Theme - April*

Course Theme - July*

Course Theme September*

Highest level of education completed*

How well do you speak English?*

Have you successfully completed a DTS?*

Yes No

Discipleship Training School (DTS) is a prerequisite for Second Level Schools within the University of the Nations (UofN).

You can proceed to submit your application however the registar office may recommend you to successfully complete a DTS.

DTS Location*

DTS Date*

Former YWAM Leader's Name*

First Name

Last Name

Former YWAM Leader's Email*

Are you currently a YWAM staff?*

Yes No

Current YWAM Base*

Current Ministry/Department*

Current YWAM Leader's Name*

First Name

Last Name

Current YWAM Leader's Email*

Are you in generally good health?*

Are you currently or have you previously suffered from any mental health conditions?*

(ie: anxiety, depression, suicidal thoughts, etc..)

Do you consider yourself to have a disability, impairment or long-term medical condition?*

Are you currently taking any prescribed medication?*

Please provide details of your health condition:*

Any food allergies?

*We can only accommodate those with life threatening allergies. Other restrictions or intolerances will be your responsibility to provide for.

Have you ever committed, been convicted of or accused of a criminal offense?*

Please explain criminal offense:*

How long have you been a Christian?*

Describe your PAST relationship with the Lord*

Describe your CURRENT relationship with the Lord*

Describe your PAST relationship with your family*

Describe your CURRENT relationship with your family*

What do you consider to be strengths in your character?*

What are some areas you are looking to grow or develop in?*

In order for you to be enrolled in this course, you'll need to supply us with two references:

Pastor/Spiritual Leader Reference First Name*

Pastor/Spiritual Leader Reference Last Name*

Pastor/Spiritual Leader Reference Email*

Friend Reference First Name*

Cannot be a family member

Friend Reference Last Name*

Cannot be a family member

Friend Reference Email*

Promo Code

Mate's Name

Name of the friend that is coming with you.

Vaccination Requirements

Proof of your immunization records are required once you've been accepted into the program. As of July 1st 2020, Hawai'i State Law requires all students (and student's children) to show proof of age appropriate vaccinations prior to arriving at the facility. These required vaccinations are: DTaP, MMR (Series of 2), MCV, Chickenpox.

I agree to send copies of my Immunization Records.*

COVID-19

You will be required to provide evidence of a negative COVID-19 test taken within 72 hours of departure.

I understand.*

Legal Agreement

Please read the following and if you are unsure of its meaning contact us for more explanation. The undersigned does hereby consent to taking part in noted activity organized by YOUTH WITH A MISSION-YWAM Ships OC (herein referred to as YWAM), a religious non-profit corporation, with full understanding insofar as such activity will involve missions and sporting activity and mingling with other individuals and groups, that treatments, and incidental loss and expense, and the undersigned does for him/herself assume the risk of such expense, does wholly release YWAM from any responsibility or liability, and waives any claims or causes of action against it, it’s agents, it’s employees, or volunteer assistants that might arise on account of loss, injury or expense occasioned by any sort of accident or other circumstance involving him/herself and agrees to hold harmless YWAM in the event any such claims should arise; and The undersigned agrees to abide by the rules and regulations, supervision and discipline set and applied by YWAM and it’s agents, and does hereby authorize YWAM or it’s staff members or other agents to arrange for and consent to x-ray examinations, anesthetic, dental, medical or surgical diagnosis, and treatment, and hold harmless YWAM for any such. The undersigned will furnish payment or insurance for any such payment, at his/her own expense.

I agree to the terms and conditions described above *

Photo Release Agreement

While I am a student / staff / volunteer with Youth With A Mission Orange County, also doing business as Youth With A Mission Ships Kona, I give my permission to be photographed or filmed during classes / sanctioned events / activities. It is understood that these images will be used only in Youth With A Mission Ships Kona publications, websites, videos, or other promotional materials. I accept that this usage may apply beyond my association with Youth With A Mission Ships Kona and does not require notification. I also accept that there will be no remuneration for any such use of images in which I am show. Releasor acknowledges that they have carefully read this agreement, fully understands its legal effects and has signed it of releasors own free will.

I agree to the terms and conditions described above *

Release of Liability Agreement

I, who is herein referred to as the "Releasor", hereby releases, waives and forever discharges YWAM SHIPS Orange County, also doing business as YWAM Ships KONA, Inc., a Californian and Hawaiian nonprofit corporation, its trustees, directors, officers, agents, employees, if any, successors, insurers and volunteers, who are herein collectively referred to as "YWAM Ships" from any and all liability, claims, causes of action, loss and damage that may result from any injury to the Releasor's person or property, even injury resulting in death of the Releasor, arising out of the Releasor being a Student, a Guest, a Mission Builder, and/or a Full Time or Associate Staff member at or of the YWAM Ships, including without limitation of the generality of the foregoing those arising out of or in any way related to the Releasor participating in any YWAM Ships conducted or sponsored program or activity whether on the YWAM Ships Kailua-Kona, Hawaii property, and/or off site, within or outside of the State of Hawaii, such as an outreach program which are usually conducted overseas. Releasor hereby acknowledges that if Releasor participates in a voyage on board one of it's vessels, or in an outreach program, conducted or sponsored by the YWAM Ships or travels internationally on YWAM Ships business that he or she is fully aware of the fact that there are inherent risks at sea, on land, and in other countries and that his or her personal health, freedom, safety and/or life may be at risk of loss or damage from injury, disability, contraction of disease, accidents, terrorism, persecution, war, political unrest and any other number of circumstances that might occur while traveling internationally or while participating in an outreach program and that the Releasor has given such risks Releasor's full consideration, prayer and thought in deciding whether or not to participate in any such activities and has given such risks Releasor's full consideration, prayer and thought before deciding whether or not to sign this instrument, and that Releasor has signed this instrument with full knowledge and acceptance of those risks, voluntarily, and not under any duress or undue influence of whatsoever kind or nature. Releasor acknowledges and accepts the fact, and assumes the risk that he/she may also be injured, disabled or even suffer death while participating and serving as a Staff, Student, Mission Builder, and/or Volunteer on property, on YWAM Ships vessels, and off property in Hawaii, and overseas. Releasor hereby knowingly and voluntarily assumes full responsibility for risk of loss of health, bodily injury, death or damage to Releasor's property arising out of the afore described risks, programs and activities. Beleasor further represents that he/she has health and medical insurance to cover all such contingencies and that insurance is current and in effect. Releasor hereby agrees to indemnify and hold the YWAM Ships har-mless from any and all claims, liability, loss, damage, cost and/or expense, including attorneys fees and costs incurred by the YWAM Ships in defending against any such claims and in enforcing this agreement, that may be asserted against the YWAM Ships or that the YWAM Ships may suffer or incur as the result of Releasor being a Student at YWAM Ships or being a Mission Builder, and/or a Full Time or Associate Staff member at YWAM Ships, as ,the case may be. Releasor expressly agrees that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Hawaii and any other jurisdiction in which any cause of action or claim may arise or be asserted and is being given as an inducement to YWAM Ships to allow Releasor to be a Student at YWAM Ships or be a Mission Builder, and/or a Full Time or Associate Staff member at YWAM Ships, as the case may be. If any portion of this agreement is deemed to be invalid by a court with competent jurisdiction, it is agreed that the balance shall notwithstanding continue in full legal force and effect.,., This release, ·waiver and indemnity agreement shall be binding on Releasor and Releasor's heirs, personal representatives, successors and assigns and shall inure to the benefit ofYWAM Ships and its trustees, directors, officers, agents, employees (if any), insurers and volunteers. 0 RELEASOR ACKNOWLEDGES RELEASOR HAS CAREFULLY READ THIS AGREEMENT, FULLY UNDERSTANDS ITS

I agree to the volunteer waiver, release and indemnity stated above *

Financial Agreement

As a community that is committed to personal accountability and discipleship, we ask each of our trainees to personally commit to be responsible for their own tuition, fees, and expenses while with us here at YWAM Ships Kona / Outpost Panama / Cap Haiti. This document serves to provide a clear understanding of the financial responsibilities of each trainee. We kindly ask you to sign this document and return it to us. By doing so, you are assuming the full responsibility for all fees associated with your enrolled status as a trainee with YWAM Ships Kona / Outpost Panama / Cap Haiti. If for some reason you are not able to meet the requirements outlined in this document, please notify the registrar as soon as possible.

	DTS Kona & Outpost Panama	Cap Haiti	Bible Core Course	Pacific Equip	School of Ministry Development	Navigation School	MMSC
Enrollment Fee: (due upon Enrollment)	$50	$50	$50	$50	$50	$50	$50
Room and Key Deposit: (due 30 day prior to Course Commencement)	$100	X	$100	$100	$100	$100	$100
Lecture Phase: (due 30 day prior to Course Commencement)	$3,995	$2,995	$3,995	$1,900	$1,450	$3,995	$2,400
Outreach Deposit: (due Week 4 of Lecture Phase)	$2,500	$2,500	$2,500	X	X	X	X
Outreach Remainder*** (due Week 8 of Lecture Phase)	unknown	unknown	unknown	X	X	X	X
Course Material Fees (due with Lecture Phase Fees)	X	X	X	X	X	$500	X

*Room and Key Deposit will be returned upon completion of course, return of key, and satisfactory room inspection. **BCC Outreach is optional. ***We are unable to give an exact outreach cost until the Outreach Deposit has been paid and flights have been booked. The cost of plain tickets change daily, so until they are purchased, total outreach cost is undetermined. Please budget between $5,000 - $5,500. Amendments / Scholarships: _________________________________ If under 18, please have your parents or legal guardians sign below. I, _________________________________, commit to paying YWAM all applicable course fees by their due dates. I accept all responsibility for my fees, visas, airfares, outreach costs, and personal expenses incurred during my involvement with Youth With A Mission, including but not limited to any deposits or change fees lost or incurred should I not complete, withdraw from, or dismissed form the course, even after course commencement.

I agree to the financial agreement as stated above*

Health Emergency Disclaimer

I understand that my medical concerns are protected and governed by HIPAA. Accordingly, I hereby waive my HIPPA rights and give permission to YWAM Ships Kona to contact my parent/guardian in case of personal or medical emergency and give express permission to the Training Director at YWAM Ships Kona to discuss my medical concerns directly with my parent/guardian.

YES NO

I agree to the Health Emergency Disclaimer stated above*

Sign here to validate your HIPPA waiver option*

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Privacy Policy Agreement

By using this form, you agree to the storage and processing of your data through this site. The data sent will be used only for the purpose of processing your request. In some cases, we may handle so-called “special categories of personal data” about you, which may be considered sensitive. Before we handle sensitive personal data about you, we require your consent to do so. We therefore ask you to use the dedicated contact forms on our website for submitting any sensitive data. The contact forms enable you to give us the consent required under applicable data protection legislation. Such consent may of course be withdrawn at any time. A limited amount of our personnel will have access to your sensitive personal data.

I agree to the privacy policy agreement stated above*

Code of Conduct Agreement

This code of conduct is in effect since April 2015, YWAM Ships Kona.

All volunteers* with YWAM Ships Kona (YSK) are expected to follow YSK policies and respect the YWAM Foundational Values.

If there is any disagreement, all parties involved are expected to bring about change through constructive dialog within the organizational structure.
Resolve any conflicts with other people as quickly as possible through humility, conflict resolution, and mediation, if needed.
Keep right relationships with one another that exhibit trust, respect, partnership, and cooperation with each other.
All volunteers are required to abstain from sexual immorality and intimate physical contact outside of marriage, which we believe, is between one biologically born man and one biologically born woman.
No participation in physical, verbal, emotional, or sexual abuse of any kind.
Volunteers must demonstrate at all times through their behavior and actions: love and acceptance of all people regardless of race, gender, social class, and religious beliefs.
Maintain healthy boundaries when working with others.
Be truthful and honest. Gossip, slander, malicious talk, theft, coarse humor, lying, and plagiarizing are never to be allowed.
Only communicate with the media on behalf of YSK with permission. Special care should be taken when expressing a personal opinion or point of view.
Generosity is our way of life.
Rooms/cabins are to be kept clean and tidy at all times. Men are not allowed in ladies’ rooms/cabins and ladies are not allowed in mens’ rooms/cabins.
Any unauthorized persons are not allowed onboard a YSK vessel or in a YSK facility. Follow ship and port authority rules regarding bringing unauthorized persons on board the vessel or to a facility operated by YSK.
The proper permits shall be obtained for any unauthorized persons to be allowed to get on board.
There is a no smoking policy on all YSK facilities, vessels, and transportation due to public health and fire safety issues. Smoking on a YSK vessel, tenders, rescue boats, and during outreach is strictly prohibited.
Storage and consumption of alcohol are prohibited onboard and in all YWAM facilities or ashore during outreach and while stationed in an outreach location. This is out of respect for cultural sensitivities and the fact that you are recognized as representing YWAM as a mission.
All volunteers are asked to ensure that they take responsibility for any prescribed medication they are taking and ensure that they make appropriate people aware of the medication they have been prescribed is likely to have an impact on their work or reasoning capacity.
Any use or dealing of illegal drugs is not allowed on board at any time and will result in instant dismissal. The matter will be referred to the appropriate authorities ashore.
Any use of betel nut in and around a YSK vessel or facility is strictly prohibited.
Firearms are not allowed onboard or near a YSK vessel or facility.

I confirm that I have read and understand the code of conduct and I will do everything in my ability to follow this code.

*Volunteers - All individuals that are officially accepted as Staff, Volunteers or Students at the Port YWAM Kona or any of its outpost locations.

I agree to the code of conduct agreement stated above*

By Typing your name here you are indicating to us that you agree with your selection above.*

First Name

Last Name

Signature

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Date

Their Court

Owner ID

Contact Type

Note: Your enrollment into the course is pending your successful completion of our enrollment process, which includes a $50 enrollment fee. Instructions for the enrollment process will be provided in an email by the registrar upon acceptance.

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