Wufoo

Which location are you applying for? *
What year will this be for you? *
Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Parent's Email *
Cell Phone Number * ### - ### - ####
Gender? *
Age? *
Birthdate *
Church Name *
Senior Pastor's Name *
Youth Pastor's Name *
Youth Pastor's Email *
Are you currently a leader at your youth group? *
Yes No
If yes, what do you do?
To attend Project Timothy, you need to commit to serving at your Youth Group in some capacity for the next year. Do you commit to doing this? *
Yes No
Do you commit to paying the $250 fee if you are accepted? *
Yes No
Are you vegan or vegetarian? *
Yes, vegan Yes, vegetarian No
Please list any food allergies.
What is your T-shirt size? *
Have you ever been convicted of a crime? *
Yes No
If yes, please explain:
Have you ever been convicted or accused of child abuse/sexual abuse or been involved in any activities related to molesting/abusing a child or a youth? *
Yes No
If yes, please explain:
Attach Your Essay *

Please write a 250-500 word short essay about why you want to attend Project Timothy, and what you hope to "get out of it."
Type your name below if all of the above information is complete and true. *
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