Mountain Mover Ministries 30 Day Challenge Application

Mountain Mover Ministries 30 Day Challenge Application

Apply to join the 30 Day Challenge program. Please complete all sections honestly and thoroughly.
Applicant Information

Please provide your basic personal details.
Full Name*

First NameMiddle NameLast Name
Today's Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number*
Please enter a valid phone number.
Social Security Number*
Email*
example@example.com
Date Available for Program*

MonthDayYear
Date
Date of Birth*

MonthDayYear
Date
Age*
Place of Birth
Emergency Contact Name*
Emergency Contact Phone Number*
Please enter a valid phone number.
Marital Status*
Wife's Name (if applicable)

Family Background

Tell us about your family.
Father's Name
Father's Age
Mother's Name
Mother's Age
Number of Brothers
Number of Sisters
YesNo
Why are you interested in the Mountain Mover Ministries 30 Day Challenge?*

Premature Departure Policy Agreement

Please read and acknowledge the following policy.
Due to the fact that some students may not complete the 30 Day Challenge of the Mountain Mover Ministries program due to dismissal or a personal decision to quit, this is the MMM Policy regarding premature departure. This page must be read, signed & dated prior to admittance.

The following will occur at the point of premature departure:

1- Anything left behind, for any reason, will become the property of MMM.

2- Student forfeits any positive references from MMM. This would include any community service hours generated.

3- If a student wishes to return to MMM there will be a 30 day period of separation prior to student re-applying. If a student is accepted back into program he starts over from the beginning.

4- Departing student is not to contact anyone in the MMM environment for 90 days. This would include Business and Church contacts made while in the program.

I have read the above premature departure information and if I for any reason leave the MMM 30 Day Challenge I agree to submit to these policies.
Signature of Applicant*

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Date Signed*

MonthDayYear
Date
30 Day Challenge Program Agreement

Please read and agree to the following statement.
I, (Student Name) agree to abide by the policies of Mountain Mover Ministries (MMM) and state that I wish to enroll in the 30 Day Challenge and realize to graduate I must remain in the program until my designated completion date.

I realize there is a $1000.00 non-refundable tuition fee due upon entry in the form of cash or a cashier’s check.

I understand that (MMM) cannot be held responsible for personal property or injury to anyone who is in our program. Any personal property or money left at (MMM) after my departure becomes the property of Mountain Mover Ministries, Inc. It is further understood that if I do not cooperate with the rules and regulations of (MMM) I can be asked to leave.

I also understand that (MMM) will allow students into the 30 Day Challenge program with “body fluid only” transmittable diseases. I will be unaware of these students and so I will practice safe hygiene and avoid contact with the body fluids of other students.

I will fully cooperate with the rules of the program on these matters.
Signature of Applicant*

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Date Signed*

MonthDayYear
Date
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Mountain Mover Ministries 30 Day Challenge Application

Applicant Information

Family Background

Education

Medical History

Religious Background

Personal Habits

Legal Record

Premature Departure Policy Agreement

30 Day Challenge Program Agreement