WinShape Pastoral Reference Form

1
Student's Name * This field is required.(Only one student per form)
First Name
Last Name
2
Parent or Legal Guardian 1* This field is required.
Mr.
Mr.
Mrs.
Prefix
First Name
Last Name
3
Parent or Legal Guardian 2
Mr.
Mr.
Mrs.
Prefix
First Name
Last Name
4
Do you, or someone on your staff, personally know the student?* This field is required.
YESNO
5
Is this student regularly involved in the church and/or youth ministry?* This field is required.
YESNO
6
Does the student regularly volunteer at/with the church?* This field is required.
YESNO
7
Would you recommend this student to serve at WinShape Camps for Communities Port Charlotte?* This field is required.
YESNO
8
Additional Comments
Huge
Large
Normal
Small
Ok
Ok
9
Pastor's Signature* This field is required.
Clear
10
Pastor's Full Name* This field is required.
First Name
Last Name
11
Position* This field is required.
12
Church* This field is required.
13
Phone Number* This field is required.
Please enter a valid phone number.
14
Email* This field is required.
example@example.com
Should be Empty: