PTL {Prepare to Lead} Retreat Registration
Please fill out the following form for the upcoming retreat.
Name: *
First and Last
Your answer
Nickname: *
What you preferred to be called
Your answer
Date of Birth: *
Your answer
Age:
Your answer
Gender:
Home Address: *
Full address
Your answer
Phone number: *
Home
Your answer
Phone number:
Mobile
Your answer
Emergency Contact & emergency contact number: *
Your answer
Email address:
Your answer
T-Shirt size:
I would like to continue getting updates on events at this email address:
How did you hear about HGMM:
Are you interested in serving with HGMM in the future?
Personality and Experiences
Please list previous experience you have had working with children? *
{For example - the number of Children's Programs, 5 Day Clubs, Good News Club, VBS, Sunday School, Co-op, 4-H, FFA, etc.}
Your answer
Explain your attitude toward work: *
Be honest, please.
Your answer
What is your attitude toward other people?
Your answer
Please explain your relationship with God: *
Your answer
How are you in a group of people?
Check the boxes that apply to you...
Medical Information
Your Name: *
Your answer
Your Phone Number: *
Your answer
Emergency Contact *
Please include contact's name, relation, and phone number
Your answer
Doctor's Name: *
Your answer
Your Doctor's Phone Number: *
Your answer
Do you have any known allergies? *
Your answer
Are you allergic to any medications or antibiotics: *
Your answer
Date of your last Tetanus shot?
MM
/
DD
/
YYYY
Name of insurance provider: *
Your answer
Insurance Provider Phone Number: *
Your answer
Policy #: *
Your answer
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