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Thank you for taking the time to complete this reference form for the student.
14
Questions
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1
Student's Name
*
This field is required.
(Only one student per form)
First Name
Last Name
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2
Parent or Legal Guardian 1
*
This field is required.
Mr.
Mrs.
Mr.
Mr.
Mrs.
Prefix
First Name
Last Name
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3
Parent or Legal Guardian 2
Mr.
Mrs.
Mr.
Mr.
Mrs.
Prefix
First Name
Last Name
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4
Do you, or someone on your staff, personally know the student?
*
This field is required.
YES
NO
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5
Is this student regularly involved in the church and/or youth ministry?
*
This field is required.
YES
NO
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6
Does the student regularly volunteer at/with the church?
*
This field is required.
YES
NO
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7
Would you recommend this student to serve at WinShape Camps for Communities Port Charlotte?
*
This field is required.
YES
NO
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8
Additional Comments
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
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9
Pastor's Signature
*
This field is required.
Clear
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10
Pastor's Full Name
*
This field is required.
First Name
Last Name
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11
Position
*
This field is required.
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12
Church
*
This field is required.
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13
Phone Number
*
This field is required.
Please enter a valid phone number.
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14
Email
*
This field is required.
example@example.com
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