Candidate Application — Missouri Valley TEC

Street Address

City, State, Zip

Phone Number

Your Custom Text Here

Candidate's Name

First Name

Last Name

Cell Phone

(###)

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Facebook

Other Social media:

Snapchat, Instagram, twitter: include name

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name You Prefer to be Called

Sex

Parent's Name(s)

Parent's E-mail Address

High School Attending:

Year of Graduation:

Grade in School:

T-Shirt Size: S, M, L, XL or 2XL

Present Church membership (or regular Attendance)

Church address

Pastor or Youth Minister's Name

Medical/Dietary/Special Needs

MEDICAL RELEASE FORM: In the event of a medical EMERGENCY, I hereby give permission to the physician selected by the TEENS ENCOUNTER CHRIST leadership to secure proper treatment for my child as named above. I certify that no guarantee or assurance has been made as to the results that may be obtained. By typing your name, you give consent.

Emergency phone number parent/guardian can be reached at:

(###)

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I recognize that churches and denominations have varied views on who may partake of communion. I understand that communion will be served at M.V.T.E.C. weekend. I have discussed this with my child and give permission for my son/daughter to make the decision whether or not to partake. PARTICIPANT'S SIGNATURE

PARENT'S SIGNATURE

The cost of the weekend is $48.00.

I will mail to Shawn Wynia % MVTEC; 27549 370th Ave; Platte, SD 57369

Venmo to SWynia

Bring to the weekend

Need a Scholarship

MISSOURI VALLEY TEC IS A SMOKE, ALCOHOL AND DRUG FREE WEEKEND! IT IS ALSO A CELL PHONE AND ELECTRONIC DEVICE-FREE WEEKEND. DO NOT BRING THEM WITH YOU TO THE WEEKEND. WE ARE NOT RESPONSIBLE FOR LOSS OF VALUABLES.