Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Phone *

(###)

###

####

Residency *

Select only one

I would like to apply for residency in the Intern Housing for $900, payable in full by June 1st.

I would like to apply for residency in the Intern Housing, payable monthly: $250 due June 1st, $400 due July 1st, $250 due August 1st.

I have local residency already provided. (Please list the address in the comments box below.)

Transportation *

I will be bringing my own vehicle. (Note: Due to limited parking at the Intern Housing, vehicles may need to be parked on rotation at the church campus.)

I will not have a vehicle. (Note: Carpooling will be available for Internship hours.)

Do you plan on working a part time job this summer? *

no

yes

Liability Waiver and Damages Responsibility *

I understand and agree to the waiver of liability against Calvary Heritage and the facility upon which it operates as set forth in the liability waiver required for enrollment. I assume all risks and agree to hold harmless Calvary Heritage and understand that I am responsible for all costs of injuries and damages.

Background Check *

I understand that, in working with children, I must have clearance through a background check and will be responsible to pay for this. $30 fee

Photo and Video Release *

I understand that I may appear in a published photograph or video used by Calvary Heritage, and that I may file a formal, written request if I do not want to appear in any publicaion.

Policies and Procedures *

I understand that I will need to still read, understand, and agree to abide by the policies and standards of the internship conduct and house guidelines.

Date

MM

DD

YYYY

Pastoral Reference *

First Name

Last Name

Phone

(###)

###

####

Personal Reference #1 *

First Name

Last Name

Phone

(###)

###

####

Personal Reference #2 *

First Name

Last Name

Phone

(###)

###

####

Today's Date *

MM

DD

YYYY

T-Shirt Size

Small

Medium

Large

X Large