Student Application
Please fill out the following application. (All sections must be filled out.)
I. Student Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Phone Number
*
Please enter a valid phone number.
Parent Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Date of Birth:
*
-
Month
-
Day
Year
Date
Gender:
*
Male
Female
T-Shirt Size:
*
XS
S
M
L
XL
XXL
XXXL
Citizenship:
*
Yes
No
Primary Language:
*
English
Ukrainian
Russian
Other
Valid Driver's License:
*
Yes
No
Upload a photo of your driver's license below.
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Upload a portrait photograph of yourself.
*
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II. Medical Disclosure Form
(All medical and personal information will be kept confidential)
Primary Care Physician:
*
Alternate Contact:
Office Phone:
*
Please enter a valid phone number.
Do you have any allergies?
*
Yes
No
If Yes, please list below:
Do you take medication(s) for your allergies:
Yes
No
If Yes, please list below.
Do you have Asthma?
Yes
No
If Yes, will you carry a rescue inhaler during school session?
If Yes, do you need staff help to use that rescue inhaler?
If Yes, what triggers the asthma?
Activity Restrictions:
Physical Handicaps:
Dietary Restrictions:
Medical History:
ADD/ADHD
Anemia
Appendicitis
Asthma
Autism
Bleeding/Clotting Disorder
BP Issues
Bronchitis
Emotional/Behavioral Issue
Concussion
Cramp, Severe
Seizures
Diabetes
IBS
Dislocations, Sprains, or Strains
Eating Disorder
Epilepsy
Migraine Headaches
Fainting or Dizziness
Heat exhaustion
Hepatitis A, B, or C
Heart Disease or Defect
Hernias
Joint or Muscle Pain
Motion Sickness
Pneumonia
Skin Conditions or Rashes
Sleepwalking
Cancer
Autoimmune disorder
Name any injuries, illness, or disabilities not mentioned and the year of occurrence:
Medications:
Please list all medications (including over-the-counter or nonprescription drugs) being taken regularly.
Medication
*
No medications taken regularly
Takes medications regularly
Medication:
blanks
Dosage:
blank
Times taken daily:
Medication:
blanks
Dosage:
blank
Times taken daily:
Medication:
blanks
Dosage:
blank
Times taken daily:
Signature
*
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Medical Insurance
Does the student have medical insurance?
*
Yes
No
Insurance Carrier: Policy Number:
Insurance Carrier's Phone Number
Please add a photo of a medical card.
*
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Bible School Participation:
Does you have any physical, emotional, mental, or physiological limitations that would affect your participation in any of our scheduled activities?
*
Yes
No
If yes, please fully describe such conditions or limitations below:
By signing below, I acknowledge that I have completed this Medical Disclosure form accurately, truthfully, and to the best of my knowledge. I further warrant and represent that if any of the information contained in this form changes at any time, I will immediately provide Philadelphia Bible School with such updated information. I acknowledge that the program will handle medications as described and that information on this form will be shared with administration on a need-to-know basis. All medical and personal information will be kept confidential to the extent required by law.
Student's Signature
*
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III. Family Information/Emergency Contact
Father's Name
First Name
Last Name
Father's Phone Number
Please enter a valid phone number.
Mother's Name
First Name
Last Name
Mother's Phone Number
Please enter a valid phone number.
Emergency Contact #1:
First Name
Last Name
Contact #1: Phone Number
Please enter a valid phone number.
Emergency Contact #2:
First Name
Last Name
Contact #2: Phone Number
Please enter a valid phone number.
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IV: Spiritual Information: (Student please answer)
Name of Church:
*
Church Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pastor's Name:
*
First Name
Last Name
Pastor's Phone Number:
*
Please enter a valid phone number.
What denomination do you belong to?
Is Jesus Christ the Lord and savior of your life?
*
Yes
No
In what language do you read the Bible?
*
English
Ukrainian
Russian
Other
What version of the Bible do you read?
*
ESV
NIV
NKJV
KJV
NASB
NLT
Other
Rate your knowledge of the Bible:
*
Below Average
Average
Above Average
Have you read the entire Bible at least once?
*
Yes
No
Are you currently involved in your local church?
*
Yes
No
Do you have musical abilities?
*
Sing
Play Instruments
No
What Instruments do you play?
Do you have experience in the following? If yes choose all that apply below.
Preaching
Leadership
Worship Group Singing
Solo Singing
Choir Singing
Tech Set-up in the Church
Sunday School Helper
Other
If you chose other, explain:
Practical Electives:
Please select a practical elective in which you would like to participate and learn from a knowledgeable instructor. Select your top 3 options. We cannot guarantee that you will get your top choice. Groups fill up on first come-first serve basis.
Teaching Children & Sunday School
Preaching/Sharing Testimony/ Public Speaking
Choir Conducting
Leading Worship/ Group Singing
Evangelism/ Witnessing Ministry
Apologetics
Hosting/leading a Bible Study group
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V. Background Information:
Have you ever been:
Arrested?
Convicted?
Expelled from School?
Do you currently use:
Tobacco/Weed/Vapors?
Alcoholic Beverages?
Drugs?
Is there anything we may need to know in regards to you legally(probation/parole)?
VI. Self Evaluation:
Main Goal for attending Bible School:
*
What theological topics are you most interested in?
*
What is your favorite activity?
*
What do you do during your free time?
*
What are some of your skills and talents?
*
Please describe what you would like to improve during Bible School:
Please honestly evaluate yourself on the following qualities:
Bad
Not too Good
OK
Good
Very Good
Character
Motivation
Leadership
Independence
Responsibility
Timeliness
Self-Control
Acceptance of others
Relationship with parents
Relationship with friends
Relationship with authority
Relationship with God
Relationship with myself
Knowledge of God/His Word
Ability to make good decisions
Ability to overcome stress
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VII. Personal Statement:
Please write a three page statement which includes your testimony (the story of your conversion to faith and repentance) and why you would like to come to Bible School. Formatting: Times New Roman 12 and Double Spaced
Upload your Testimony:
*
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Did you use AI to write any part of the personal statement?
*
Yes I did
No I did not
Student's Signature
*
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VIII. Permission/ Signature's
I certify that all of the information and statements on this application are complete and accurate to the best of my knowledge. I have read and agree to obey and follow all rules, regulations and the schedule of Philadelphia Bible School. In the event that I do not obey and follow all rules, regulations, and schedule of Philadelphia Bible School, my parents and pastor will be notified and I may be asked to leave the remainder of the school without a refund or certificate. In case my application is denied, I will receive a full refund.
Student's Signature:
*
Participant release/waiver of liability and indemnification agreement
Student Information
*
First Name
Last Name
I am at least eighteen (18) years of age. In consideration of being permitted to participate in the Philadelphia Bible School (“PBS”), a ministry of Evangelical Pentecostal Church (“EPC”), I knowingly, voluntarily, and willingly agree to the following:1. Rules and ConductI agree to become familiar with and abide by all rules, policies, instructions, and guidelines established by Philadelphia Bible School and EPC. I understand and acknowledge that EPC reserves the right, in its sole discretion, to suspend or terminate my participation at any time if I fail to comply with such rules or for any other reason deemed appropriate by EPC.2. Physical Condition and FitnessI affirm that I am physically and mentally capable of participating in Philadelphia Bible School activities and that I am not suffering from any condition, impairment, disease, or illness that would prevent me from safely participating or that would pose a risk to others. I accept full responsibility for following any medical restrictions, prescriptions, or limitations applicable to my physical condition or state of health.3. Medical Treatment AuthorizationI understand and agree that, in the event it becomes necessary for me to receive medical treatment during my participation in Philadelphia Bible School, reasonable efforts will be made to contact the emergency contact(s) listed on my Medical Disclosure Form. However, if such contact cannot be made, I hereby authorize EPC and its representatives, leaders, volunteers, or agents to seek and authorize medical treatment on my behalf. This includes, but is not limited to, selecting and authorizing licensed medical professionals to provide care as deemed necessary under the circumstances, including hospitalization, injections, anesthesia, surgery, or other medical treatment. I acknowledge that I assume all risks related to any medical or physical condition I may have and that I am responsible for providing accurate and current medical information.4. Insurance and Financial ResponsibilityI understand that any health insurance listed on my Medical Disclosure Form will be the sole insurance coverage available for me in the event of injury or illness. I acknowledge that EPC does not provide health, medical, or accident insurance coverage for participants. I agree that I am solely responsible for any medical expenses, charges, or costs not covered by my insurance, or for all costs if I do not have valid insurance coverage.5. Media ReleaseI hereby grant permission to Philadelphia Bible School and EPC to use my image, likeness, and/or voice as captured in photographs, audio recordings, or video recordings for lawful purposes related to the ministry, including but not limited to printed materials, websites, social media, videos, and promotional or educational content. I understand that no personal identifying information will be used without my consent.6. Assumption of RiskI understand that participation in Philadelphia Bible School may involve activities that carry inherent risks, including but not limited to physical injury, illness, or other harm. I voluntarily assume all such risks, known and unknown, associated with my participation, including travel to and from activities.7. Release and Waiver of LiabilityExcept where prohibited by law, and except for claims arising from the gross negligence or willful misconduct of EPC, I hereby release, waive, discharge, and covenant not to sue Evangelical Pentecostal Church, Philadelphia Bible School, and their directors, officers, employees, volunteers, agents, representatives, contractors, and affiliates (collectively, “Released Parties”) from any and all claims, demands, actions, or causes of action arising out of or related to my participation in Philadelphia Bible School, including but not limited to claims for personal injury, property damage, loss, or wrongful death.8. IndemnificationI agree to indemnify, defend, and hold harmless the Released Parties from any and all claims, liabilities, damages, losses, costs, or expenses (including reasonable attorneys’ fees) arising out of or related to my actions, omissions, or participation in Philadelphia Bible School.9. Governing LawThis Agreement shall be governed by and interpreted in accordance with the laws of the Commonwealth of Pennsylvania.10. AcknowledgmentI acknowledge that I have carefully read this Agreement, fully understand its terms, and voluntarily agree to be bound by it. I understand that by signing this document, I am waiving certain legal rights.
I certify that all of the information and statements on this application are complete and accurate to the best of my knowledge. Parent or Guardian Signature:
*
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IX. Pastor/Youth Leader Recommendation
Please provide your pastor's/youth leader's information below. Youth Leader's phone and email are mandatory. Pastor's phone and email are strongly recommended so that we can get in direct contact with them regarding their recommendations. Please reach out to provide as much information as possible-thank you!
Pastor's Name
*
First Name
Last Name
Pastor's Email (Strongly Recommended)
example@example.com
Pastor's Phone Number
*
Please enter a valid phone number.
Youth Leader's Name
*
First Name
Last Name
Youth Leader's Email
*
example@example.com
Youth Leader's Phone Number
*
Please enter a valid phone number.
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X. Application Checklist
Before you send your application, please check for:
Fully completed application
Personal Statement Essay/Testimony
Completed Pastor's Recommendation/ Youth Leader's Application
Copy of Medical Insurance card
Copy of Driver's License (if student has a license)
Student Photograph (Passport Style)
Post Admission Requirements:
*
Payment is due by May 1st; otherwise, the spot will be forfeited. (Once the application is accepted the payment will be requested.)
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