Infusion 2020 - Application & Payment Form

Student Information:

Hey there, you can use this form to apply and pay for Infusion 2020. At the end of this form you'll be asked to pay the tuition fee so please make sure and have the card you'd like to use ready. A portion of this payment will count towards your non-refundable $15 application fee.

Which experience are you signing up for?

First Name:

Last Name:

Email Address:

Phone Number:

Date of Birth:

Age:

Gender:

Boy Girl

Grade level 2020-2021:

Timezone Region:

T-Shirt Size

Shirts are standard adult sizes.

Parent/Guardian Info:

Parents First Name:

Parents Last Name:

Parents Email:

Parent's Address:

City:

State:

Zip:

Group Information:

How will you be watching?

With my youth group

With friends

By myself

Names of friends you'll be watching with:

Personal Information:

Tell us about yourself…

What was your salvation experience...

Why do you want to be a part of Revival Training? What are you hoping to learn/grow in?

What is revival to you?

Do you have a dream for your High school, if so; what?

What topics would you like to hear about during Revival Training?

List any symptoms you've had with mental illness i.e. depression, anxiety, suicidal thoughts, self harm, ADHD, ADD, bipolar disorder, PTSD, eating disorder**

Build Your Team:

How many people do you think you can gather?

Would you want to have CRYTH Staff come and facilitate this training?

Yes

No

Could you provide housing for 3-5 Circuit Riders?

Yes

No

Where could you gather?

Are you parents stoked?

Yes

No

Payment Information:

Your card will be charged today.

For tuition cost minus early bird discount if applicable.

First Name:

Last Name:

Email Address:

A payment receipt will be sent to this email address.

Expiration Date:

CVC:

Zip/Postal Code:

Credit Card Number

Infusion 2020 – Application & Payment Form

Student Information:

Parent/Guardian Info: