For Your Glory 2016 Application

March 17-20, 2016

Please print clearly and complete all sections.
Send application and payment to:
The Move church
1071 Taylors Mill Road
Gretna, VA 24557
themovechurchgretna@gmail.com 434-713-4455 or 516-509-1703

APPLICANT
NAME ________________________________________________
ADDRESS ____________________________________________
Street/P.O. Box

______________________________________________________
City State/Province Zip Code

PHONE (______) ______-_______ !.Home !.Cell AGE ______

E-MAIL ___________________________________________
GENDER !Male

!Female

BIRTHDATE ____/____/____

T-SHIRT SIZE:!S !M !L !XL !2X !3X

ROOMMATE REQUEST _______________________________
Please note: Attendees should plan to arrive no earlier than 2:30 p.m. Thursday, March 17th and leave no later than 3:00 p.m.
Sunday, March 20th.

EMERGENCY CONTACT
NAME__________________________ ____________________
Relationship to Applicant

PHONE (______) ______________ !.Home !.Cell

PAYMENT
!
!
!

$125 Early Rate: Postmarked on or before February 1

$150 Regular Rate: Postmarked on or before March 16
$165 Late Rate: Register upon arrival

Check or money order (enclosed) #_________________

***Credit card payment will not be processed
!

Make checks or money orders payable to The Move. There is a $35 fee for canceling after March 1, 2016.

CHURCH INFORMATION
CHURCH NAME _______________________________________
ADDRESS ____________________________________________
Street/P.O. Box

______________________________________________________
City State/Province Zip Code

PASTORS NAME __________________________________

YOUTH PASTORS NAME ____________________________

CHURCH PHONE (______) ______________
CHURCH E-MAIL ___________________________________________

RULES

Follow all counselor directions

Curfew must be observed unless in a scheduled activity

No unauthorized absences

No pairing off in couples

No smoking, drugs or alcohol

Any property damage will be paid for by the attendee

No guys allowed in girl rooms and no girls allowed in guy rooms

We expect all attendees to uphold Christ-like attitudes and actions.

DRESS CODE
Pants: Neat jeans or khakis
Shirts: T-shirts (no objectionable content) or dress shirts
Girls: Dresses or skirts must be knee-length or longer. Shorts should be fingertip length or longer, and shirt straps at
least an inch wide.
***Counselors will determine the appropriateness of dress. Please dress modestly and neatly!

MEDICAL INFORMATION
Below, please list any prescription medications you will be taking during the conference or any medical conditions we
should be aware of:
________________________________________________________________________________________________
________________________________________________________________________________________________
____________________________________________________________________________________

WHAT TO BRING
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Your Bible
Your instrument, if portable
Notebook and pen
Blanket and pillow (sheets will be provided)
Towel, washcloth and toiletries
Winter appropriate clothing
Money for Snack Bar (optional)
Sneakers
Flashlight

APPLICANT SIGNATURE
I have read the For Your Glory rules listed on this application and I agree to abide by them. I understand that if I willfully break any
of the rules, I will be sent home at my parents expense.
By attending For Your Glory, I understand that The Move church reserves the right to use my picture in any future publications.

APPLICANTS SIGNATURE __________________________________________________

PARENT/GUARDIANS PERMISSION
I release The Move church from any and all liability in case of accident or illness during any activity, both on- and off-campground,
and while being transported to or from functions during For Your Glory, March 17-20, 2016.
I authorize any medical care deemed necessary by an accredited physician, nurse or hospital.
I have read the rules for the For Your Glory conference listed on this application, and I agree to let my child be governed by them.

PARENT/GUARDIANS SIGNATURE _________________________________________________