I am applying for the Introduction to Christian Sex Therapy No Yes

Mr. Mrs. Miss Ms.

Name: Surname:

Preferred Name:

Country:

Date of Birth:

Present Address:

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Email Address:

Though every effort is made to provide a safe environment, Youth with a Mission – England Limited, their agents, employees, and other volunteer assistants are insured against loss or injury through their negligence. Participation in a Youth with a Mission organised programme, event or outreach is entirely at the participant’s own risk.

I have read and agree with the Declarations above.

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