Application Form - Step 2

Emergency Contact

Name Relationship

Address (Street, City, Province, Postal Code, Phone)

Home Church Information

Home Church Phone #

Address

Applicants Information

Mr. Mrs. Miss.

First Middle Last

Permanent Address (Street, City, Province, Postal Code, Phone #)

Present Address (Street, City, Province, Postal Code, Phone #)

Birthdate Place of Birth Age

Marital Status

Single Engaged Married Separated Divorced Remarried Widowed

Spouse's Name

Children

Name Birthdate Grade in school

Name Birthdate Grade in school

Name Birthdate Grade in school

Name Birthdate Grade in school

Health History

Please state any physical impairment or conditions requiring medical attention. Give Detail

Educational History

High/Secondary school or equivalent from which you graduated or will be graduating

Name Location

Date of Graduation

I have not completed High/Secondary school

Last year of education completed

Have you previously attended College, University, Other?

Name Address

Dates Degrees

Name Address

Dates Degrees

Have you previously attended Bible Schoo? No Yes

IF YES

Name Place Dates

Name Place Dates

Financial Support

From?

Do you have your complete school fees?

Do you have an outstanding debt? Please explain:

What will your spouse be doing while you are attending GMTC?

*By filling this out, your spouse has read and agreed to the above.

Confidential Health Form

This information is treated confidential

Please answer all questions. Comment on all positive answers in the space below. Have you ever had, or do you have any of the following?

Are you presently under a doctor's care for any condition? Yes No

Specify:

Are you taking any medication at this time? Yes No

Specify:

Do you now/have you ever received any compensation for disability from any source? Yes No

Specify:

Height Weight (lbs)

Overweight Underweight

Have you ever had any of the following communicable diseases?

Other, please specify

Have any of your relatives ever had any of the following?

Physician's Name

Address

Acknowledgement of financial responsibility

I understand that payment of the required school tuition fees must be made on the first day of every month, or first day of every trimester, or upon my arrival, unless otherwise approved in writing by the School Director before enrollment. I agree to participate in designated fundraising events to cover extra costs for outreach purposes. Further, I agree to meet in a timely manner, prior to the completion of school, all expenses incurred during my involvement with Kelowna Christian Center Global Ministry Training Center. If I am accepted by K.C.C. G.M.T.C. I will abide by the spirit, rules, and schedule of the school.

By checking this box I hereby acknowledge this responsibility.

Release of liability

I/We do hereby release K.C.C., its staff, agents and volunteer assistants from any liability whatsoever arising out of any injury, damage or loss which may be sustained by said person(s) during the course of involvement with K.C.C. G.M.T.C.

By checking this box I hereby digitally sign this, and a parent or guardian (if under the age of 18) has read and agreed also.

Consent for Treatment

In case of emergency I/We hereby agree to the performance of such treatment, including anaesthesia and surgery, as the attending doctor or physician may deem necessary.

I agree, if under the age of 18 a parent or guardian has agreed also.

Statement of confirmation to all students

WE BELIEVE THAT A CONFIRMATION TO ALL STUDENTS, AS WELL AS THE ADMINISTRATION, OF GOD'S TIME FOR STUDYING AT KELOWNA CHRISTIAN CENTER GLOBAL MINISTRY TRAINING CENTER WILL BE YOUR ABILITY TO MEET THE FINANCIAL REQUIREMENTS.