School of Life Covington Registration

learn to walk with Jesus

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Personal Information
Name*
First Last
Birthday*
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Gender*
Marital Status*
Have you ever been arrested?*
- Yes
- No
When and where?*
Have ever been convicted of a misdemeanor or felony?*
- Yes
- No
When and where?*
Education
Are you currently enrolled in any educational program/school?*
- Yes
- No
Please list the name of program/school:*
Current Employment
Occupation*
Employer*
Address*
Phone*
Emergency Contact
Name*
First Last
Phone*
Email*
Church History
Are you currently attending church?*
- Yes
- No
Church Name:*
Pastor's Name*
Church Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
What area of the Kingdom of God do you feel you have been called to?
What do you want to get out of this mentorship?*
Have you received salvation in the baptism of the Holy Spirit?*
- Yes
- No
What is your belief on salvation?*
I understand that any falsification of the information on this application is grounds for dismissal at any time.*
- Yes
Date*
Signature / Initials*
Non Refundable Registration Fee
School of Life - Registration Fee*
- Individual ($300)
- Couple ($450)
Credit Card*
Card Details
Cardholder Name

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