FatherHeart Ministries “A” School

Application:

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School Location*
School Location*
Please indicate which School Location you Desire to Attend:
Applicant Information*
First Last
Preferred Name*
(Think "Nametag")
Date of Birth*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Marital Status*
For "B School" Applications only
A prerequisite for a B School is either attendance at an A School, the Gathering or INS. Please give approximate dates and location of any one of the above.
What is your reason/motivation for wanting to attend this “A” School?*
What changes/breakthroughs do you hope to see in your life after attending this school?*
Medical Health
Are you under psychiatric care or counseling? (Please Describe).
Food Allergies*
Are there any specific food allergies we need to be made aware of during this week?
How would you rate your Health ?
Emergency Contact*
In case of any problems during your stay, we would appreciate the address and telephone number of an emergency contact and their relationship to you. This should not be the person attending with you.
First Last
Emergency Contact Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact Phone*
Emergency Contact Email (if applicable)
Emergency Contact relationship to you*
APPLICATION SIGNATURE AND RELEASE OF LIABILITY*
I have read the application form in its entirety.
I, *applicant*, hereby indemnify and hold Fatherheart Ministries, and it’s officers, staff, representatives, and employees in conjunction with the Fatherheart Ministries “A” School harmless for any damages, injuries, and loss or damage to personal property incurred from my participation in any activities associated with this event now or during the terms of agreement. I understand that in case of illness, injury, accident, or any other damage to my person or property while participating in the “A” School which may require attention by a physician and/or hospitalization; I will bear the expense personally or by insurance that I have provided for myself. Any other cost or damages such as the cost of transportation by an emergency vehicle or damages to third persons, is also to be paid by me or by my own insurance. I give permission to be included in occasional email mailings.
I acknowledge that I understand the content of this statement. I acknowledge that it is legally binding and I sign it out of my own free will.
Date*
Date of submission
MM slash DD slash YYYY

FatherHeart Ministries “A” School

Application:

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