Youth Rush

Application

* Indicates required field.

Name

First

Last

Your Address*

Address 1

Address 2

City

State

Postal Code

Country

Cell Number

Home Number

Preferred Contact Method

Mail

Phone

How old will you be by June 6, 2010?*

Under 16

16-17

18 or older

If hired, can you provide written evidence that you are authorized to work in the United States?

Yes

Date school year ends

What are your favorite hobbies?

Why would you like to join Youth Rush this summer?Please be specific

Reference #1 NamePastor or Teacher

First

Last

Reference #1 EmailPastor or teacher

Reference #1 Phone Number