Training Course “Valley of Happiness”

Training Course “Valley of Happiness”

(Aghveran, Armenia)

Participant’s Personal Details

Please complete this form and email it by 1^st of December 2013 to

[e-mail]

Where relevant tick the box (X)

PERSONAL DETAILS

Name

Surname

Date of birth

Gender

Nationality

CONTACT DETAILS

Address

Mobile

Telephone (landline)

E-mail

OCCUPATION/PROFESSION

YOUR ORGANISATION’S DETAILS

Name

In Latin

Address

E-mail

Telephone

Web site

EMERGENCY CONTACT INFORMATION (NEXT OF KIN)

Name

E-mail

Address

Telephone

SPECIAL REQUIREMENTS

vegetarian, vegan, food allergies, etc.

YES

NO

Specify

medical needs, allergy, disability, etc.

YES

NO

Specify

SHARING CONTACT DETAILS WITH OTHER PARTICIPANTS (If you agree, please leave the paragraph below how it is. If you disagree, please delete the paragraph below or some part of it)

I confirm that I am happy for my details to be shared with the other participants on this project. I am also happy for any photos taken at the training to be uploaded onto the organisers’ Facebook page (please note that you will not be ‘tagged’ by us. These are my details:

Name, Surname

E-mail address

Facebook

LEARNING STYLES How do you learn new things? “I learn best if...

I see pictures or drawings!”

When we talk about it!

I read about it or write it down!

I work it out for myself

LEVEL OF ENGLISH Tick the relevant box please (use the letter X or V)

Fluent

Good

Basic

Beginner

YOUR ROLE IN YOUR ORGANISATION

YOUR EXPERIENCE/BACKGROUND IN YOUTH WORK

YOUR EXPERIENCE IN YOUTH IN ACTION

WHAT IS YOUT MOTIVATION IN PARTICIPATING IN THE PROJECT?

WHAT IS YOUR EXPECTATION?

o I hereby declare that I have carefully ad entirely read and understood the Project Description

o I hereby commit myself to participate in the whole process of this project

o I am aware that obtaining a health and a full travel insurance are my own responsibility and at my own expense. I understand that the information I have provided on my special needs does not remove my own personal responsibility for ensuring my own health

o I hereby declare that everything stated in the present form corresponds to the truth

Confirmation of Participation in The Training Course

I, (name / surname), confirm my participation in the Training Course

“Valley of Happiness”

Which will take place in Aghveran, Armenia from 15/02/2014 to 24/02/2014.

I also confirm:

1. Full participation in the Training Course. I understand that if I will not attend fully in the exchange prove with my declaration that I may not receive any reimbursement of my travel costs.

2. I will be responsible for covering 30% of my overall travel costs.

3. I will prepare relevant materials in time for the Training Course sessions, if needed.

4. I intend to participate in all evaluation activities during the training course and after its completion.

5. I will show openness and respect towards other participants and all other individuals involved in the program.

6. The Code of Conduct requires participants, facilitators and staff to respect each other's dignity, values, religion and culture, irrespective of race, gender, national or ethic origin, religion, sexual orientation, age or disability.

I, the undersigned, hereby confirm my participation and agree fully with the above stated.
Date		Place
Signature

Дата добавления: 2015-11-04