Prayer Walk Champion Form

First Name *

Last Name *

Phone *

Email *

What city/region are you in?Region *

Address *

City *

State *

Postal code *

Date of birth *

*Volunteers under 18 must have a Youth/Minor Waiver signed by a parent/guardian before participating.

Church *

Emergency Contact Name *

Emergency Contact Phone Number *

How do you plan to serve? *

Background Check (Saturday Prayer Walk Volunteers Only)

I consent to a background check required by Love Life USA, and upon completion of this application I will submit my background screening application (Fee of $13.00 required by applicant) *

I agree

Upon submission of this form, we will send you an email with the link to the background check.

I have read and agree to abide by the Prayer Walk Code of Conduct. *

Yes

I have read and agree to abide by the Confidentiality Statement. *

Yes