Online Candidate Application

NORTHWEST TEENS ENCOUNTER CHRIST

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Northwest teens encounter christ

Candidates must be 16 years of age or will turn 16 prior to the next TEC weekend.

Candidate Application

* Indicates required field

Candidate Name *

First

Last

Nickname (If applicable) *

Gender *

Male Female

Adult/Teen *

Adult Teen

Address *

Line 1

Line 2

City

State

Zip Code

Country

Today's Date *

Date of Birth (Ex. 6/2/1978) *

Age on the weekend *

Candidate must be 16 years of age or will turn 16 prior to the next TEC weekend.

Email *

Phone Number *

School *

Year of Graduation *

Choose One *

Sophomore Junior Senior Other

If teen doesn't attend, parent will be notified. *

Agree Disagree

Church/Parish *

Church/Parish City *

Referred By: *

Referrer's Phone Number *

Mother's Name *

First

Last

Father's Name *

First

Last

Mother's Address *

Line 1

Line 2

City

State

Zip Code

Country

Mother's Email *

Father's Address *

Line 1

Line 2

City

State

Zip Code

Country

Father's Email *

Mother's Phone Number *

Guardian's Name (If not mother/father) *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone *

Father's Phone Number *

What activities have/do you participate in at your school? *

What are your plans for the immediate (next few years) future? *

Please give a brief description of what you expect to gain from this TEC experience. *

Do you have any special needs (medical, physical, etc.)? *

Please List Any Food Allergies or Special Diet *

Submit

Northwest TEC * Believers' Together Center * 3209 60th Street Moline, IL 61265 * Phone: 309-507-1807 * Email: northwest.webmaster@gmail.com

Home
About
Get Involved
Upcoming Weekends
Parents' Corner
Contact Us