Extreme Bible Workout Application

July 4-24, 2018

We look forward to knowing you better & helping you have an experience you will not forget! No funds are due by submitting this application. Regular registration is $500. If you register by June 1 you receive 10% discount. $200 is due by June 8. The remaining balance is due June 27. After submitting this application you will receive communication regarding your application. If accepted you will receive an acceptance packet that includes all the forms your parents need to fill out and the packing list and schedule and everything you need to know to prepare for this exciting trip. Let me know if you have any questions. ~ Pastor Joe

Contact Information

First Name *

Last Name *

Date of Birth * +

Address 1 *

City *

State *

Zip *

Phone *

Email Address

Gender *

Parent/Guardian Information

First & Last Name(s) *

E-mail: *

Primary phone: *

Alternate Phone:

Church & School Information

What church do you normally attend?

Who is your pastor?

Where do you attend school?

Projected grade level for Fall 2018 *

Summer Desires

In a few sentences please answer the following questions:

Why do you want to attend Extreme Bible Workout? *

What do you hope to gain from the experience? *

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