APPLICATION REGISTRATION REQUIRED INFORMATION

Instructions for Sponsors:
Sponsors should obtain the following information from each pilgrim so that the sponsor can submit an on-line application.  After you receive these answers, it is the responsibility of the sponsor to use that info to fill out the form in step 3.

As a sponsor, you have three ways to obtain this information.

  • Talk:  Talk with the person you want to sponsor in person or by phone, and ask these questions verbally as you write in all answers;
  • Email:  Highlight and copy all text below, and paste it into an email to your pilgrim;
  • Print:  You can print this page, or push the button to open a PDF that you can print.

Be sure to ask them to return the completed form back to you.

REGISTRATION TO ATTEND A GRACE EMMAUS WALK WEEKEND

Dear friend,

Thank you for your interest in attending a Walk To Emmaus weekend. This information below is needed for me to register you to attend the Walk weekend.  Please PRINT your answers clearly and accurately in a reply message to me. Thanks!

PART 1 – CONTACT INFORMATION:

 

Name (First / Last) =Address =

City, State, Zip =

Mobile Phone = ( ) – –

EMAIL: Address =   _______________________ @ ________________._____

Your age =

Gender: M F =

Marital Status: (M S D W SEP) =
(married/single/divorced/widowed/separated)

 

Name you want on your name tag =

 

PART 2 – HEALTH, MEDICAL & CHURCH:

Emergency Contact & Phone = name & phone ( )- – =

Name & Phone of nearest relative = name & phone ( )- – =

Name & Phone of a friend emergency contact = name & phone ( )- – =

Are you on a medically prescribed diet for allergies/vegetarian/etc? Y / N =
Describe if Yes =

Do you take special medications? ( Y / N) =

Do you have health needs or a physical handicap that may affect your attendance at a Walk to Emmaus? If yes, please specify =

Name and denomination of church you attend =

What church activities are you active? =

*

*

*

*

PART 3 – AGREEMENT:

A. Has the “Walk to Emmaus” been explained to you by your sponsor? (Y/N) =

B. Have the activities of the Emmaus weekend and Emmaus community

        been explained to you? (Y/N) =

C. Please state why you wish to be involved in the Emmaus Community

        and what you expect from it:

D. I agree to release Grace Emmaus of Silicon Valley and its volunteers, agents and Board of Directors and the host church from any and all liability for and waive any and all claims for injury, loss or damage in any way connected with my participation in Grace Emmaus Of Silicon Valley activities or programs.   (Yes or No) =  ______

 

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Answer all above questions in Part 1, 2 and 3, and email this back to your sponsor, and your sponsor will then enter this information into our on-line application process.

When you arrive at the walk, you will be asked to verify your information is correct and also sign the above statement of liability release (Part 3 – D).

Thank you for agreeing to attend a Walk. We praise God for you, and will pray for you now and through the Walk. If you have any further questions, please talk with your sponsor to get all questions answer. Once this application has been approved, your sponsor will be notified, and your sponsor will confirm with you everything you need to bring on the Walk.