Applicant Information

First Name

Last Name

Birthdate

Grade (if in High School)

Email

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Allergies

Do you require any advanced accommodations for learning? (i.e. ADHD, Autism Spectrum, and/or any physical limitations etc.)

How can we best support you in the program? Specifically in the classroom.

Are you currently employed?

Will your job be flexible to the hours of the program? (Tuesday-Thursday 9:00am-5:00pm)

Do you have reliable transportation?

Do you have health insurance?

If yes, please email a copy of your insurance card to Amanda@newcitychurch.net

Guardian Information

First Name

Last Name

Email

Phone Number

Church Information

What church do you attend?

Have you chosen to receive the free gift of Salvation

Briefly explain your moment of salvation. (i.e. I was led to the Lord by... I found Jesus at...)

Have you been water baptized

Tell Us About Yourself!

What are you hoping to get out of the Align program?

What are some areas in your life that you are wanting to experience change?

How do you respond to situations that are challenging or out of your comfort zone?

Tell us about your most important relationship. Why is it so important to you?

Explain your relationship with your parent (s)/guardians

Do you have a relationship with your Pastor/Youth Pastor/Youth Leader?

Describe the relationship with your Pastor/Youth Pastor/Youth Leader (including their name)

Are you currently in a dating relationship?

What standards do you currently hold in the relationship?

If you could complete the program with one area of your life different. What would it be?

Program Fee Information

The total cost of the Align Summer Program is $350. A deposit of $50 is required at time of application.

All applicants are required to pay the $50 deposit to complete the application process. This includes applicants who plan on requesting sponsorship.

To make any of the below payment options, simply scroll to the bottom of the Align Page.

Payment Options

Do you plan on requesting sponsorship?

Personal Commitment

We ask all Align applicants to make a personal commitment to be fully engaged in the program. We understand not everyday will be the best day, but we ask each applicant to commit to a great start and an even better ending.

We fully believe what you put into this program is what you will get out of it. Therefore, by completing this application and signing below you are making a personal commitment to yourself and to us, to go ALL IN and see what God can do in 8-week.

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