WYA Africa | Furaha Camp | Fun, Sun and Dignity
Sat 12th to Sat 19th December 2015
Venue: Kivukoni International School, Kilifi, Kenya
APPLICATION FORM
Please answer using Block Letters. Incomplete forms shall be disqualified.
Notes:
1. English will be the working language of the camp.
2. Upon acceptance to the camp, we will require parental consent to attend the camp.
PART 1: PERSONAL INFORMATION
Last Name:
First Name:
Middle Name:
Names as you’d like to appear on certificate:
Sex (Male or Female):
Country of Residence:
Address:
Birth date:
Email:
Mobile number:
T Shirt Size(for Camp T Shirt):
Languages spoken:
Nationality:
Identification Type (e.g. Passport, School ID):
Identification Number:
PART 2: OCCUPATION
Present Occupation/Designation/Position:
If Student, Current Institution of Study:
PART 3: PARENTS AND EMERGENCY CONTACT
Emergency Contact Person Name/Relationship:
Mobile number:
Address:
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World Youth Alliance Africa  Furaha Afrika Camp  Sat 12 – Sat 19 Dec 2015  africa@wya.net
PART 4: EDUCATIONAL BACKGROUND
Name of School/Institution
Years Attended
Primary School
Secondary/High School
Tertiary/University
PART 5: CLUB/ORGANIZATONAL AFFILIATION (Maximum of five recent affiliations)
Name of Organization
Designation
Year (s) of membership
Accomplishment
PART 6: Medical Condition, Food Restriction and Special Needs
Allergies:
Food/Dietary Restrictions:
Special Medication:
Do you have any disabilities or recurrent health condition? If yes, please specify.
PART 7: Additional Information
Are you a World Youth Alliance member? If not, do you want to become a member?
What are your expectations at the 2015 Furaha Afrika Camp?
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World Youth Alliance Africa  Furaha Afrika Camp  Sat 12 – Sat 19 Dec 2015  africa@wya.net
What talents/skills/knowledge can you showcase to others to make the Camp more exciting?
What are your hobbies/interests?
PART 8: Statement
I hereby certify upon my honour that all facts and information indicated herein are true and
correct to the best of my knowledge. I further declare any information given by me that is
untrue may constitute a disqualification to the Furaha Camp. The undersigned expressly
authorizes World Youth Alliance Africa or its representatives to use, share, and process the
personal information I have provided, shared, or declared in this form for any lawful purposes.
Further, I subscribe and agree that the World Youth Alliance Africa has the sole prerogative to
select the participants to the camp, and its decision is final. IN WITNESS hereof, I am
executing and signing this statement voluntarily without compulsion.
__________________________________
NAME:
(Signature Above Printed Name)
PART 9: Essay
A. What do you understand by human dignity? (maximum 100 words)
PART 10: World Youth Alliance Charter
Only sign below the Charter if you are not yet a member of World Youth Alliance, and you would like
to become one.
The World Youth Alliance is composed of young women and men from every part of the world. In
cooperation with other organs of the international community, primarily the United Nations and the
European Union, the World Youth Alliance is committed to building free and just societies through a
culture of life. That culture affirms the inalienable dignity of the person, defends the intrinsic right
to life, nurtures the family, and fosters a social climate favourable to integral development,
solidarity, and mutual respect.
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World Youth Alliance Africa  Furaha Afrika Camp  Sat 12 – Sat 19 Dec 2015  africa@wya.net
We recognize that the intrinsic dignity of the person is the foundation of every human right. We
believe this dignity is independent of any individual condition and that no human community can
grant or rescind that dignity.
We are convinced that the intrinsic dignity possessed by every human being from conception to
natural death is the foundation of everyone’s right to life. We believe that this inalienable right to
life is the basis of a free and just society and we believe that society through law and culture has an
obligation to protect the dignity of the person and thus protect the right to life.
We affirm that the fundamental unit of human society is the family, where women and men learn to
live in genuine freedom and solidarity, and where individuals are equipped to fulfil their social
obligations. We believe that the political community at the local, national and international level is
obliged to protect and nurture the family.
We believe that the authentic development of society can occur only in a culture that fosters
integral human development – characterized by physical, spiritual, mental, and emotional growth, in
a climate of respect for the human person and the family.
We invite all those who share these convictions to join us in affirming them and giving them effect in
public life at all levels.
__________________________________
NAME:
(Signature Above Printed Name)
Save your application form either in .PDF or .DOC format. If you’re returning your filled
application through email, don’t forget to write in the subject line CAMP APPLICATION:
(COMPLETE NAME).
For Inquiries: Please contact us via email africa@wya.net or through phone +254-202-508-626.
You may also visit our website on specifically the Camp at www.wya.net/furahacamp.
Applications can also be received via post through our address: P.O. Box 24021, 00100,
Nairobi, Kenya.
Thank you and we look forward to receiving your application soon!
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World Youth Alliance Africa  Furaha Afrika Camp  Sat 12 – Sat 19 Dec 2015  africa@wya.net
Application Deadline
Friday 20th November 2015
Payment Deadline:
All payments to be made on or before Friday 27th November 2015
Camp Fee
The camp fee is 15,000 KSHS (or 150 USD)
The camp fee includes 7 residential nights in Kivukoni International School in Kilifi, Kenya,
travel to and from Nairobi (for those who will require this), meals, WYA Africa Camp Kit and
camp material (including certificate, t-shirt, study material), WYA t-shirt.
Note: Boys and girls will be assigned separate spaces for accommodation.
All other travel, lodging, visa and tax expenses before and after the camp will be the sole
responsibility of the participant. WYA Africa will maintain correspondence with applicants,
to enable a smooth travel experience.
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World Youth Alliance Africa  Furaha Afrika Camp  Sat 12 – Sat 19 Dec 2015  africa@wya.net