LIT Form

*Denotes Required Field

Personal Information

* First Name

* Last Name

Phone ( ) -

Email

Address

City

State / Province / Region

ZIP / Postal Code

Country

Birthdate

Gender

Male
Female

Church Background

Do you currently attend a church?

Yes
No

Ministry Experience

Have you worked with children at a camp in the past?

Yes
No

Medical Information

Medical Care Card Number

Family doctor

Family doctor phone ( ) -

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number ( ) -

Any physical conditions we should know about?

Any allergies we should know about?

Reference 1

First Name

Last Name

Phone Number ( ) -

Email

Your relationship with this person

Reference 2

First Name

Last Name

Phone Number ( ) -

Email

Your relationship with this person

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