Session *

Next Available (TBA)

How would you like us to follow up with you? *

By Phone

By Email

By Mail

In Person

Have you attended other discipleship programs? *

Yes

No

Not Sure

Applicant Name *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian 1 *

First Name

Last Name

Parent/Guardian 2

First Name

Last Name

Will you be able to afford the full cost of the program? *

The full cost of the program is $575 + $100 registration fee. Please answer as truthfully as you can. Answering "yes" does not automatically prevent you from receiving financial assistance.

Yes

Maybe

No

Statements *

In order for this enrollment to be accepted a parent/guardian must agree to the following statements (students over eighteen assume this role):

(1) I hereby acknowledge the registration fee ($100) that will be made is a non-refundable payment.

(2) I hereby recognize this student is enrolling in a discipleship program that involves common sense rules and reasonable expectations, and I grant Thoughtful Life Ministries the authority to hold this student accountable to them while they voluntarily attend the program. I also hereby recognize that Thoughtful life Ministries has the right to dismiss them from the program, at its own discretion, for disorderly or inappropriate behavior.

Signature Date *

MM

DD

YYYY