The Upper Room

GRACE Emmaus COMMUNITY of the CAROLINAS, Inc.

(To be referred to hereafter as GEC)

 

Postmark __________

RETURN TO SPONSOR

Check # __________

SPONSOR'S NAME____________________________________

Deposit __________

 

 

TO BE FILLED IN BY CANDIDATE

 

 

1.       NAME______________________________________________ PHONE (               ) ___________________________________

2.       ADDRESS ________________________________CITY __________________________STATE_______ ZIP_______________

E-MAIL ADDRESS _______________________________________________________________________________________

3.       NAME DESIRED ON NAME TAG _________________________________________ AGE_____        MALE____ FEMALE ____

4.       PASTOR'S NAME ___________________________________CHURCH_____________________________________________

5.       WHAT ACTIVITIES WITHIN YOUR CHURCH DO YOU PARTICIPATE IN OR HAVE YOU PARTICIPATED IN? ______________________________________________________________________________________________________

6.       MARRIED ________         SINGLE ________         WIDOWED ________         DIVORCED _______       SEPARATED _______

7.       PRESENT OCCUPATION _________________________________________   COMPANY______________________________

8.       IN WHAT COMMUNITY ORGANIZATIONS ARE YOU ACTIVE? ___________________________________________________ _______________________________________________________________________________________________________

9.       HAS THE WALK TO EMMAUS BEEN EXPLAINED TO YOU?      Yes ______ No ______

10.    HAS THE FOLLOW-UP MEETING BEEN EXPLAINED TO YOU?      Yes _____ No ______

11.    HAS THE MONTHLY GATHERING OF THE EMMAUS COMMUNITY BEEN EXPLAINED TO YOU?      Yes ______ No ______

12.    HAS THE GROUP REUNION PROGRAM BEEN EXPLAINED TO YOU?      Yes ______ No ______

13.    STATE BRIEFLY WHY YOU WISH TO ATTEND THE WALK TO EMMAUS AND WHAT YOU EXPECT FROM IT:  _______________________________________________________________________________________________________ ________________________________________________________________________________________________________

14.    ARE YOU ON A DOCTOR PRESCRIBED DIET?      Yes _____ No_____   IF YES, TELL US HOW WE CAN BEST SERVE YOU. (NOTE:  PLEASE INFORM YOUR SPONSOR OF ANY OTHER DIETARY NEEDS SO THAT HE/SHE CAN PROVIDE IT FOR YOU ) ________________________________________________________________________________________________________

15.    DO YOU HAVE ANY ALLERGIES, FOOD OR OTHER, THAT WE NEED TO BE AWARE OF?  Yes _____ No______  IF YES, LIST:___________________________________________________________________________________________________

16.    DO YOU HAVE A HEALTH PROBLEM OR A HANDICAP THAT MAY AFFECT YOUR ATTENDANCE ON THE EMMAUS WALK?       Yes ______ No ______ IF YES, TELL US HOW TO MAKE YOUR WEEKEND EASIER.   ________________________________             _______________________________________________________________________________________________________

17.    ANY DIFFICULITIES WALKING SHORT DISTANCES?  Yes ___ No___  UPHILL?  Yes ___ No___   DOWNHILL? Yes ___ No___ 

18.    WOULD YOU BE WILLING TO SLEEP ON A TOP BUNK?  Yes _____ No______ 

19.    GIVE NAME, ADDRESS, PHONE NUMBER OF NEAREST RELATIVE NOT LIVING WITH YOU: NAME________________________________________________________  PHONE (             )__________________________         ADDRESS ________________________________CITY __________________________STATE_______ ZIP_______________

20.    UPON COMPLETION OF THE WALK WEEKEND, I WISH TO BE A MEMBER OF GEC.    YES______   NO _______

21.     SIGNATURE________________________________________ DATE: _____________________                              

22.     IMPORTANT: ALL OF THE ABOVE INFORMATION IS NECESSARY FOR YOUR PROPER PLACEMENT ON A WALK TO EMMAUS.  PLEASE FILL IN ALL BLANKS.  PLEASE ENCLOSE A NON-REFUNDABLE PRE-REGISTRATION DEPOSIT 0F $25.00.  THIS WILL BE APPLIED TOWARD YOUR CONTRIBUTION OF $125.00, WHICH PARTIALLY OFFSETS THE EXPENSES OF YOUR WEEKEND.   MAKE CHECK PAYABLE TO GRACE EMMAUS COMMUNITY OR GEC.  THE REMAINING BALANCE WILL BE DUE PRIOR TO SEND-OFF FOR THE WEEKEND.

GRACE Emmaus COMMUNITY of the CAROLINAS, Inc.

 

SPONSOR'S FORM

 

CANDIDATE’S NAME   _______________________________________

1.                   NAME (S)___________________________________________ ADDRESS_______________________________________

2.                   CITY_________________________________   STATE________________   ZIP ____________

3.                   TELEPHONE:  HOME ( ____ ) ________________    WORK ( ____ ) ________________ CELL (____) ________________

E-MAIL ADDRESS ____________________________________________________________________________________

4.                   NAME & DENOMINATION OF CHURCH NOW ATTENDING _______________________________________________________________________________________

5.                   DO YOU ATTEND REGULARLY? __________ WHAT CHURCH ACTIVITIES DO YOU (HAVE YOU) PARTICIPATED IN? ________________________________________________________________________________________________________________________________________________________________________________________________________

6.                   WAS YOUR WALK   EMMAUS _____ CURSILLO _____ CHRYSALIS _____ OTHER __________________________

7.                   WHERE _____________________________   WHEN___________________________   WALK #_____________

8.                   NAME OF YOUR REUNION GROUP ______________________________ MEETS ________________________________

9.                   DO YOU PARTICIPATE IN MONTHLY COMMUNITY GATHERINGS?    YES_____ NO _____

10.                NUMBER OF CANDIDATES YOU ARE SPONSORING ON THIS WALK _________

11.                HOW LONG HAVE YOU KNOWN YOUR CANDIDATE?  ________________________________
HAVE YOU ATTENDED A SPONSORSHIP TRAINING CLASS?   YES_____ NO_____

12.                IS CANDIDATE ACTIVELY PARTICIPATING IN A LOCAL CONGREGATION?   YES_____ NO _____

IN WHAT WAYS DO THEY SERVE?  _____________________________________________________________________

____________________________________________________________________________________________________

13.                IF MARRIED, BOTH SPOUSES ARE EXPECTED TO ATTEND THE WALK TO EMMAUS. IN THE EVENT THAT ONE SPOUSE DOES NOT WISH TO ATTEND, HAVE YOU APPROACHED THE COUPLE AGAIN AFTER A MINIMUM SIX-MONTH PERIOD FROM FIRST CONTACT TO ASCERTAIN IF THAT SPOUSE HAS CHANGED DECISION?              YES_____   NO _____   N/A _____

 

14.                AFTER PRAYERFUL CONSIDERATION, DO YOU RECOMMEND THAT THE MARRIED SPOUSE ATTEND AS A "SINGLE" (SUBJECT TO # 13 ABOVE?) YES_____ NO _____  N/A _____

15.                DOES YOUR CANDIDATE HAVE THE PHYSICAL HEALTH TO PARTICIPATE IN THE 72-HR WEEKEND WALK?

                YES____ NO____  IF NO, EXPLAIN WHAT WE NEED TO DO TO MAKE PARTICIPATING POSSIBLE.

 ____________________________________________________________________________________________________

16.                HAVE YOU DISCUSSED YOUR CANDIDATE’S DIETARY NEEDS, AND ARE YOU PREPARED TO PROVIDE SPECIAL FOODS NEEDED IF NOT DOCTOR PRESCRIBED?  YES____  NO ____

17.                IS YOUR CANDIDATE UNDER ANY EMOTIONAL STRAIN?   YES____ NO ____ IF YES, PLEASE EXPLAIN: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

18.                I  UNDERSTAND THE SPONSOR'S RESPONSIBILITIES AND OBLIGATIONS AND PLEDGE TO SUPPORT MY CANDIDATE BEFORE, DURING, AND FOLLOWING THE WALK.

 

SPONSOR'S SIGNATURE: __________________________________________________      DATE: _________________________

 

ALL BLANKS MUST BE FILLED IN ON BOTH SIDES AND DEPOSIT OF $25.00 INCLUDED OR APPLICATION WILL BE RETURNED TO THE SPONSOR FOR COMPLETION.

 

RETURN TO:

GEC Registrar

 

P.O. Box 1876

 

Shelby, NC 28151-1876