Application form for the Experiencing Father's Love A School

The Corrymeela Centre, 5 Drumaroan Road, Ballycastle, Co Antrim, BT54 6QU, Northern Ireland 24th – 30th October 2010

Please fill out the online form to apply for a place on this school. All forms must be fully completed. Please complete one application form for each individual applicant, even if you are attending as a couple.

A deposit of 20% of the registration fee per person is required with your application form. Cheques should be made payable to ‘Father's House Europe’. Credit card or BACS payments are also accepted. Details on the Pay Deposit and Pay Balance pages.

*Please complete one application form for each individual applicant, even if you are attending as a couple.

If you prefer to download this form and print it, fill it in and post it, then click here. You will need a pdf reader to see this form. If you do not have this on your computer you can download it free from: Adobe

Please complete all fields.

Contact Details

• Name:
• Email address:
• Telephone:
• Date of Birth:
• Gender: Male Female
  

Address Details

• Address 1:
• Address 2:
• Town:
• Post Code:
• Country:

Please answer the following questions as honestly and openly as you can. All answers will be treated in the strictest confidence.

What is your reason/motivation for wanting to attend this ‘A’ School?

• Answer

What changes/breakthroughs do you hope to see in your life after attending
this school?

• Answer

MEDICAL HEALTH

• Do you have any special needs/requirements, or special dietary requirements which we need to be aware of in order to facilitate your attendance at the school?
• Do you suffer from any health conditions or illnesses which it would be helpful for us to be aware of (eg heart trouble, diabetes, epilepsy, asthma, allergies etc)? If so, are you on any special medication related to those conditions?

EMERGENCY CONTACT

• In case of any problems during your stay, we would appreciate the address and telephone number of an emergency contact and their relationship to you.

• Name:
• Address:
• Telephone(including international code):
• Relationship to you:

ACCOMMODATION

• In the main residential block at Corrymeela the following accommodation is available: single rooms, twin rooms, 3-bed rooms (1 single and 2 bunk beds) and 4-bed rooms (2 singles and 2 bunk beds).
• I would like to book a residential place:
  • The number of single rooms is limited. Are you willing to share a room with another person or persons if necessary?
  • Yes
  • No
  • Share with / comments etc...
• I will arrange my own accommodation

PAYMENT OF FEES

• Please tick your payment method for your deposit, or full fee by card, Bank Transfer or (cheque UK only).
• Card:
• Bank Transfer:
• Cheque (UK only):

APPLICANT’S SIGNATURE

• By clicking the 'send application form' button I certify that all the information in this application is complete and accurate.