Breakthrough Weekend Assistant Sign-up
Please fill out this form in its entirety and submit an assistant fee of $30.00 by Friday night of the course. This covers your meals for the Weekend and can be paid via venmo, cash, check, or paypal!

Have you purchased a new T-Shirt/Tank/Hoodie?
They are not required, but highly encouraged! (they are soft and awesome) https://www.thebreakthroughweekend.com/online-store
Email address *
First and Last Name *
Your answer
Name on Name Tag *
Your answer
Preferred Pronouns on name tag (optional)
Your answer
Course you are signing up for: *
Date of Birth (MM/DD/YYYY) *
Your answer
Full Mailing Address *
Your answer
Phone Number *
Your answer
Have you assisted before? *
If you have only assisted at other centers, please list which ones:
Your answer
What are your food preferences? *
Required
*We will do our best to provide a variety of food options, but to take the best care of yourself it may be in your best interest to bring your own meals/snacks. *
Assistant Agreements *
All boxes must be checked in order to assist.
Required
Meeting Times *
Required
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