Shenandoah Valley Emmaus Pilgrim Application
To be completed by the Applicant. A $35 Application Fee is required and is payable with this form submission. Each pilgrim is sponsored by an individual(s) who have experienced Emmaus or similar 3 day weekends. Your sponsor will help prepare you for your Emmaus Walk and support you in various ways. They will complete their own form to partner with yours for a complete application.
First Name *
Your answer
Last Name *
Your answer
Name as your would like it on a name badge *
Your answer
Street Address *
Your answer
Town *
Your answer
State, 2 letter abbreviation *
Your answer
5 digit Zip Code *
Your answer
Preferred Phone with Area Code *
Your answer
Is this a mobile phone
Email address for confirmation *
Your answer
Age
Your answer
Date of Birth *
MM
/
DD
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YYYY
Gender *
Occupation *
Your answer
Marital status *
Spouse's Name
Your answer
Has your spouse attended Emmaus?
Has your spouse submitted an application to attend a Walk?
Do you require any physical assistance to attend? If so, please describe... *
Your answer
List any important food allergies/restrictions that may require special attention by Food Service.
Your answer
List any other health problems that may affect your attendance.
Your answer
List any medications and times to be taken other than at meal time, bedtime, or awakening.
Your answer
What faith community are you active in? Church Name *
Your answer
Denomination
Your answer
Town church is located in
Your answer
Your pastor's name *
Your answer
Your pastor's email address *
Your answer
Your sponsor's name *
Your answer
Your sponsor's email or phone *
Your answer
Briefly share why you wish to attend an Emmaus Weekend, what you hope from it, or anything else you would like to share.
Your answer
The application fee is $35.
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