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Project Shine Participant Registration 2022
June 19-24, 2022
Hosted at Goss Memorial Church: 2247 11th St SW, Akron, OH 44314
Contact us for more information at (330) 573-9591 or
projectshineakron@gmail.com
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* Required
Participant's First Name
*
Your answer
Last Name
*
Your answer
Preferred Email Address
*
Your answer
I am participating as a....
*
Student - Full Week Participant
Pastor/Organization Leader
Adult - Full Week Participant
Adult - Partial Week Participant
Other:
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Preferred Phone Number
*
Your answer
Gender
*
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Have you participated in the past?
*
Yes
No
T Shirt Size (Adult Sizes)
*
XS
S
M
L
XL
XXL
Other:
Affiliated Church/Organization Name
*
Your answer
Youth/Church Leader or Pastor's Name
*
Your answer
Experience/Skills
Climbing Tall Ladders
Landscaping
Carpentry
Painting
Tech/Video/Photography
Sharing Testimony
Dramas/Skits
Worship/Band
Evangelism
Children's Ministry
Cooking/Meal Time
Driving (15 Passenger Van)
Other:
ADULTS PARTICIPANTS ONLY - Availability
Morning
Afternoon
Evening
Flexible
FULL DAY
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Morning
Afternoon
Evening
Flexible
FULL DAY
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Clear selection
Committed a Crime?
*
Yes
No
If Yes, explain...
Your answer
Health Insurance Provider
*
Your answer
Policy/ID Number
*
Your answer
Insurance Phone Number
*
Your answer
Date of Last Tetanus
*
MM
/
DD
/
YYYY
Allergies & Reactions...
Your answer
Medical Conditions...
Your answer
Medications
Your answer
(1) Emergency Contact Name
*
Your answer
(1) Emergency Contact Phone Number
*
Your answer
(1) Relationship of Emergency Contact
*
Your answer
(2) Emergency Contact Name
*
Your answer
(2) Emergency Contact Phone Number
*
Your answer
(2) Relationship of Emergency Contact
*
Your answer
I have reviewed the expectations for involvement in the 2022 Project Shine work week.
*
Yes
Required
I have reviewed the General & Financial Info for involvement in the 2022 Project Shine work week.
*
Yes
Required
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