Please acknowledge you have read the above notice and agree with it before filling in this form: Please acknowledge you have read the above notice and agree with it before filling in this form: I Agree

Please select one: Please select one: 1 - 4 July 2024

First Name

Family Name

First Name for Name Tag

Age

Sex SexMaleFemale

Marital Status Marital StatusSingleMarriedSeparatedDivorcedRemarried

Place of birth

Nationality

Do you need a visa for France? Do you need a visa for France? Yes No

Your Email

Your full permanent postal address

Your telephone you will be traveling with (including country code)

Organization for which you work

Your title/role in organization

Do you have health insurance that is valid in France? Do you have health insurance that is valid in France? yes no

I wish to be lodged at Le Rucher: I wish to be lodged at Le Rucher: yes no

Have you been professionally diagnosed with: Have you been professionally diagnosed with:NoneDiabetesCeliac DiseaseSevere Lactose IntoleranceNut allergies

You must have already attended a Basic Debriefing Training of the Le Rucher "Exchange at the Cross Debriefing" Model. Where and when did you attend this and who were your trainers?

Have you ever been accused or found guilty of emotional, physical or sexual abuse of a minor child?

Describe your present involvement with member care and/or work with children. Include what role you have now and what role you expect to have immediately following the training. If you do not presently have a role and/or expect to have one immediately, please explain your timeframe.

How will you use this training in the 6 months following the training? Please include what type of people you will work with (i.e., missionaries, pastors, church members, community members, children of missionaries) and in which country(ies) and/or people groups. Also include whether or not you will be in the nation(s) involved when you are providing the debriefing.

Please describe any previous training or experience you have had in pastoral care, debriefing or work with children.

Does your organization support your desire to be involved in the care of children/member care? If so, please explain what opportunities they will provide for you to use the training. If not, how do you intend to structure a ministry of debriefing?

When and where were you last debriefed?