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Youth Summit Application

When you’re ready to apply, simply fill out the application below and we’ll get back to you shortly!

Note: All fields are required unless you don’t meet a stated conditional (such as being over 18 and not needing parental approval). If you have any trouble filling out this form, please email magabook@youthsummit.info

About You

In which conference would you like to participate? *

Full Legal Name *

First

Last

Email *

Cell Phone *

Home Phone

Date of Birth *//

Current Age *

Marital Status *

Single
Married

Gender *

Male
Female

Do you have a Social Security Number? *

Yes
No

Do you have a Student Visa?

Yes
No

Home Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

School Information

School Name *

Phone *

School Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Current Field of Study *

Where will you attend school next year? *

How long have you been a Seventh-day Adventist? (Years) *

Have you ever canvassed before? *

Yes
No

Why do you feel called to canvass? *

Why did you sign up for magabook canvassing?

Earliest date that you will be available *

Your Favorite Hobbies *

Your Favorite Music Groups *

References

Name *

First

Last

Email *

Phone *

Name *

First

Last

Email *

Phone *

Health Insurance

If you do not have health insurance, it will be provided to you for a nominal fee

Are you covered under a health insurance plan? *

Yes
No

Checkboxes *

I have read and understand that insurance will be purchased for me.

IMPORTANT: Since you are not covered under a health insurance plan, insurance will be purchased on your behalf for a nominal fee.

Allergies and Medications

Are you taking any medications? *

Yes
No

Are you allergic to any medication? *

Yes
No

Do you have any food allergies *

Yes
No

Parent(s) or Guardian

Required, if you are under 18

Name *

First

Last

Email *

Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent/Guardian Agreement

Upon receiving this application a call will be made for verification of this agreement.

I hereby agree to give permission for my son/daughter to canvass this summer *

Yes
No

Disclaimer

All students are subject to a background check under the Federal Fair Credit Report Act. Failure to consent to the consumer report, including the criminal record check, will result in ineligibility to participate in our program. You will be asked to sign a consent form authorizing this.

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