Personal Data of Spouse/Fiancé(e) First Name Last Name Area Code Phone Number Marriage DetailsDate of Legal Marriage: Date City Council Church Customary Have you been married before? Yes No If yes;How many time's Date of last marriage Date(s) of Divorce(s) Number of Children from previous marriage If married before, do you pay alimony or child support?Yes No If Yes, include this amount, if No explain Do you have children out of wedlock? Yes No How many do you support? Spouse's Spiritual DetailsIs your spouse born again? Yes No Will your spouse be attending RBTCZ? Yes No Has your spouse previously attended RBTCZ? Yes No If Yes, which year? FIRST YEAR SECOND YEAR Did your spouse graduate? Yes No Is your spouse in agreement that you attend RBTCZ? Yes No If No, explain why Will your spouse (and your dependent family) be residents with you while you attend RBTCZ? Yes No (We encourage married couples to be in residence together from registration to graduation. We do not encourage the separation of families in order for you to attend RBTCZ) Will you be responsible for any dependent(s) during your period of studies? Yes No If Yes, give details of dependents whom you will be supporting as breadwinner using your earnings, e.g. children or relatives such as grandparent(s Name and Surname Age Relationship
Answers will not be used as grounds to decline any applicant’s entry into RBTCZ. These answers will be kept confidential by RBTCZAre you presently taking any medication? If Yes, What type of medication/drug(s) How often do you take it? Name of the attending physician (If you are currently on any medication for any sickness or disorder, a letter of recommendation from your doctor must accompany this application).Have you taken any drugs for a long period? Do you have any known drug allergies? Do you have physical disabilities? and would you require special facilities?
Have you ever been a patient in a mental hospital/sanatorium?Yes No * If Yes, Name of hospital Name of Doctor Reason
Medical Consent: “I hereby grant permission to RBTCZ or a consulting physician to render to me any emergency treatment or medical care that might be deemed necessary. When necessary for executing such care, I grant permission for hospitalisation at an accredited hospital. This healthcare will be covered at my own cost. I will not hold RBTCZ liable for any expense occurred.
If Yes, explain briefly:
If Yes, Employers Address Employers Phone number Area Code Phone Number
Church Address * Address Line * Name of Pastor: First Name Last Name Pastor's Mobile No. Phone Number
APPLICANT'S DECLARATION: "I understand that course of study at RBTCZ is a two-year program. In order for me to obtain a certificate or Diploma I must comply with the attendance and academic requirements for the entire year of study.”
Next of Kin:First Name* Last Name* Phone Number* Street Address* Home Line* City* Province*