Castalia Baptist Church College Tour 2020 Application and Approval Form
UPDATED Feb 24, 2020: The list of schools has been changed, and the length and the price of the college tour has been reduced. The deadlines for deposit and full payment have also been extended.

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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 Sunday, March 1, 2020.

Scheduled Dates of College Tour: Monday, March 16, 2020 thru Wednesday, March 18, 2020

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

Cost Per Student:
- $105 for members of Castalia
- $260 for non-members of Castalia
- $35 deposit due by March 1, 2020 for all applicants

Balance due by March 9, 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 9, 2020:
6:00PM Required Orientation Meeting at Castalia Baptist Church

Monday, March 16, 2020 thru Wednesday, March 19, 2020:
Jackson State University Jackson, MS

Tougaloo College Jackson, MS

Dillard University New Orleans, LA

Xavier University New Orleans, LA

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 Wednesday, March 18, with overnight stays in New Orleans 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 *
Cell Phone of Student
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 *
Parent's Cell Phone *
Home Phone
Home Address *
City *
State *
Zip *
Home Church, if applicable
Email
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
Is the student taking any medications? *
If so, please identify
Personal health/accident insurance carrier *
Policy Number *
Family Doctor *
Family Doctor's Telephone Number *
Emergency Contact Person *
If above Parent/Guardian is not available in the event of an emergency, notify this person
Emergency Contact Phone Number *
Emergency Contact Relationship to Student *
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.
Submit
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