APPLICATION

Name *
Name
Address *
Address
Date of Birth
Date of Birth
Home Phone *
Home Phone
Cell Phone *
Cell Phone
Marital Status *
Earliest Date Available *
Earliest Date Available
The summer program starts May 24, 2015
If accepted we need this picture for your ID. Passport style with a White background. Thank you
http://
Go to your profile and copy the link of your profile and paste it here.
http://
Do you have a Social Security number? *
Are you baptized? *
In the Adventist Church
Parent/Guardian Agreement
If student is under age 18
Health Insurance
Are you covered under a Health Insurance plan? *
If yes, please bring proof of insurance upon day of arrival
I hereby agree to give permission for my son/daughter to canvass this summer or winter. *
Select all that apply
IMPORTANT: In case of an emergency or illness, I hereby give my permission to the physician selected by MagaMinistry directors to hospitalize, secure proper treatment, and to order injection, anesthesia, or surgery for my child. I realize I am responsible for payment of illness. Accidents, only while workering, are covered by Worker's Compensation. *
Select all that apply
Parent/Guardian Information
Please provide as much information as possible
Name *
Name
Address *
Address
Phone Number *
Phone Number
Alternate Phone Number *
Alternate Phone Number
DISCLAIMER
All students are subject to a background check under the Federal Fair Credit Report Act. Failure to consent to the consumer report, including the criminal record check, will result in ineligibility to participate in our program. You will be asked to sign a consent form authorizing this.

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