Spring Application

Personal Information

* Current Photo

* First Name

* Last Name

* Birthdate

Marital Status

* Gender

Home Phone

Cell Phone

Do you have a Social Security Number?

School Information

Name

Street Address

City

State

ZIP

Phone Number

Your Major

About You

Are you a Seventh-day Adventist?

No Yes

Why do you want to canvass this spring?

Your Favorite Hobbies

Your Favorite Music Groups

Health Information

Are you taking any medications?

No Yes

Medicine Allergies?

No Yes

Food Allergies?

No Yes

Are you covered under a health insurance plan?

No Yes

I understand that basic medical coverage is required to participate in this program. It can be made available at a minimal per week charge. (for more information contact your canvassing leader)

You must provide proof of insurance.

Parent/Guardian Information

First Name

Last Name

Street Address

City

State

ZIP

Work Phone

Evening Phone

References

Enter the email addresses for two references. They will be sent a form to fill out. Your application will not be processed until we receive responses from both references, so you may want to check that they have received and completed the form. References must be a teacher, pastor, or work supervisor. No relatives.

Reference #1 Email

Reference #2 Email

Parent/Guardian Agreement (if under 18)

I hereby agree to give permission for my son/daughter to canvass this spring.

Yes No

IMPORTANT: In case of an emergency or illness, I hereby give my permission to the physician selected by MagaMinistry directors to hospitalize, secure proper treatment, and to order injection, anesthesia, or surgery for my child. I realize I am responsible for payment of illness. Accidents, only while working, are covered by Worker's Compensation.

Yes No

I agree to a background check.

Yes No

Spring Application

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