For Your Glory 2017 Application

June14June17,2017
Pleaseprintclearlyandcompleteallsections.

Sendapplicationandpaymentto:
TheMove
1071TaylorsMillRoad
Gretna,VA24557
themovechurchgretna@gmail.com|4347134455or5165091703
APPLICANT

NAME________________________________________________
FullName

ADDRESS____________________________________________
Street/P.O.Box

______________________________________________________AGE______
CityState/ProvinceZipCodeAsofJune14,2017

PHONE(______)_____________.Home.Cell
EMAIL___________________________________________
GENDERMaleFemaleBIRTHDATE____/____/____
TSHIRTSIZE:SMLXL2X3X
ROOMMATEREQUEST_______________________________
Pleasenote:Attendeesshouldplantoarrivenoearlierthan2:30p.m.Wednesday,June14thandleavenolater
than3:00p.m.Saturday,June17th.

EMERGENCYCONTACT

NAME__________________________RELATIONSHIPTOAPPLICANT____________________
PHONE(______)______________.Home.Cell

PAYMENT

$105EarlyBirdSpecial:PostmarkedonorbeforeApril30th
$125Registration:ReceivedbeforeJune14th
$145LateRegistration:Registeruponarrival
Checkormoneyorder(enclosed)#_________________
*Creditcardpaymentwillnotbeprocessed*
MakechecksormoneyorderspayabletoTheMove.Thereisa$35feeforcancelingafterJune1,2017.

 CHURCHINFORMATION

CHURCHNAME_______________________________________
ADDRESS____________________________________________
Street/P.O.Box
______________________________________________________
CityState/ProvinceZipCode

PASTORSNAME__________________________________
YOUTHPASTORSNAME____________________________
CHURCHPHONE(______)______________
CHURCHEMAIL___________________________________________

RULES

Followallcounselordirections
Curfewmustbeobservedunlessinascheduledactivity
Nounauthorizedabsences
Nopairingoffincouples
Nosmoking,drugsoralcohol
Anypropertydamagewillbepaidforbytheattendee
Noguysallowedingirlroomsandnogirlsallowedinguyrooms
WeexpectallattendeestoupholdChristlikeattitudesandactions.

DRESSCODE

Pantsandshortsshouldbeneatandclean.Shortsshouldbefingertiplengthorlonger.Tshirtsordress
shirtsareappropriate(noobjectionablecontent).Shirtstrapsmustbeatleastaninchwide.Dressesor
skirtsmustbekneelengthorlonger.
***Counselorswilldeterminetheappropriatenessofdress.Pleasedressmodestlyandneatly!

MEDICALINFORMATION

Below,pleaselistanyprescriptionmedicationsyouwillbetakingduringtheconferenceoranymedical
conditionsweshouldbeawareof,includingallallergies:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________



APPLICANTSIGNATURE

IhavereadtheForYourGloryruleslistedonthisapplicationandIagreetoabidebythem.Iunderstand
thatifIwillfullybreakanyoftherules,Iwillbesenthomeatmyparentsexpense.
ByattendingForYourGlory,IunderstandthatTheMovechurchreservestherighttousemypicturein
anyfuturepublications.


APPLICANTSSIGNATURE__________________________________________DATE____________

PARENT/GUARDIANSPERMISSION
IreleaseTheMovechurchfromanyandallliabilityincaseofaccidentorillnessduringanyactivity,both
onandoffcampground,andwhilebeingtransportedtoorfromfunctionsduringForYourGlory,June14
June17,2017.
I authorize any medical care deemed necessary by an accredited physician, nurse or hospital. I have
includedallmedicallyrelevantinformationasrequestedonthisform.
IhavereadtherulesfortheForYourGloryconferencelistedonthisapplication,andIagreetoletmychild
begovernedbythem.
PARENT/GUARDIANSSIGNATURE_________________________________________________









WHATTOBRING
YourBible Sneakers/showershoes
Yourinstrument,ifportable Swimsuitandtowelforactivities
Twinairmattressandsleepingbag (Girls:Nobikinis/baremidriff)
(FullorQueensizesareallowedif Insectrepellent
sharingwithfamilyorafriend) Sunscreen
Blanket,sheetsandpillow Flashlight
Notebookandpen Notebookandpen
Towel,washclothandtoiletries MoneyforSnackBar(optional)