Castalia Baptist Church College Tour 2020 Application and Approval Form
Please complete this application for each student. Additionally, please email or deliver a copy of the student's latest report card to the College Tour director at emeka2001@gmail.com or to the church office no later than Wednesday, February 26, 2020.

Scheduled Dates of College Tour: Monday, March 16, 2020 thru Thursday, March 19, 2020

Open to Students: Grades 9-12 only; first-come, first-served basis

Cost Per Student:
- $130 for members of Castalia
- $335 for non-members of Castalia
- $35 deposit due by February 26, 2020 for all applicants

Balance due by March 4, 2020 for all applicants.

Payment Options:
Cash
Check (made out to Castalia Baptist Church)
PayPal (link at http://castaliachurch.org/?page_id=393 AND include student name)


IMPORTANT DATES:

Monday, March 09, 2019:
6:00PM Required Orientation Meeting at Castalia Baptist Church

Monday, March 16, 2019 thru Thursday, March 19, 2019:
Jackson State University Jackson, MS

Tougaloo College Jackson, MS

Dillard University New Orleans, LA

Xavier University New Orleans, LA

Prairie View A&M University Houston, TX

Texas Southern University Houston, TX

Wiley College Marshall, TX

Grambling State University Grambling, LA

Tour will leave from Castalia Baptist Church early on the morning of Monday, March 16 and return late evening on Thursday, March 19, with overnight stays in New Orleans, Houston, and Shreveport, LA.

*Schedule and schools are subject to change


For questions/information about this College Tour or problems with this application, please contact:
Bro. Meka Egwuekwe
College Tour Director
Castalia Baptist Church
emeka2001@gmail.com
901-484-4203 (mobile)

CHURCH CONTACT INFORMATION
Castalia Baptist Church
2180 Airways Blvd, Memphis, TN 38114
901-276-7295 (office)
IDENTIFICATION
Castalia respects privacy. This information is kept secure and confidential.
Name of Student *
Your answer
Cell Phone of Student
Your answer
Student's Date of Birth *
Please member to set the correct year!
MM
/
DD
/
YYYY
Student's Grade *
Student's Gender *
Name of Parent or Guardian *
Your answer
Parent's Cell Phone *
Your answer
Home Phone
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Church, if applicable
Your answer
Email
Your answer
HEALTH AND MEDICAL EMERGENCY INFORMATION
This information is kept secure and confidential.
Does this student have any medical conditions, including allergies, of which we should be aware? *
If so, please identify
Your answer
Is the student taking any medications? *
If so, please identify
Your answer
Personal health/accident insurance carrier *
Your answer
Policy Number *
Your answer
Family Doctor *
Your answer
Family Doctor's Telephone Number *
Your answer
Emergency Contact Person *
If above Parent/Guardian is not available in the event of an emergency, notify this person
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Relationship to Student *
Your answer
Signature (Please Type Parent's Name Here) *
Type the name of the parent here. Additionally, this application will be presented on paper to you at the required orientation for your signature.
Your answer
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