Trainee Application

Note:  Fill out this form for consideration in our program. All fields are required.

Trainee Information

First Name:
Last Name:
Gender:  
 
Age:
Address:
City:
State/Province:
Zip:
Country:
Phone Number:
E-mail:
Desired Arrival Date:
Desired Departure Date:

Parent Contact Information

First Name of Parent/Guardian:
Last Name of Parent/Guardian:
Home Phone:
Work Phone:
Cell Phone:
Other Emergency Contact
& Phone Number(s):

Medical Information

Please list any medical conditions or health concerns that we should be aware of:
Please list any allergies to food, medication, animals, or plants/insect bites:
Please list any diet restrictions:
Please list any prescription medication being taken:

Parent Release Permission

As Parent/Guardian I hereby authorize the Campaus to secure medical services as may be deemed necessary for my child’s health and safety. I will be informed immediately of any medical services that are required. I release Timothy and Shannon Campau from any and all liability claims resulting from illness, accident, and/or misfortune:  
 

Trainee Essay

Please write a paragraph for us telling about yourself,
your personal walk with our Creator,
why you wish to be our trainee,
what you are hoping to accomplish,
and how you hope to benefit from it: