// Street Invaders :: Youth Summer Missions Program //

2012 Street Invaders Application

This application must be completed in FULL by ALL participants.
All fields are required.

I am applying to be a:

Street Invader
(Must be the age of 13 years of age as of June 1st of program year)

Junior Leader
(Must be 16 years of age by June 1st of the program year and have been on Street Invaders for 1 year.)

Assistant Leader
(Must be 18 years of age by June 1st of the program year, out of high school and have been in leadership positions in the past.)

Last Name:

First Name:

Mailing Address
Number & Street:

City:

Province:

Postal Code:

Email:

Home Phone Number:

Cell:

Work Phone Number:

Fax:

Gender: Male Female

Date of Birth (yyyy/mm/dd ):

Age as of June 1st of program year:

Healthcare Number:

Healthcare Province:

T-Shirt Size:
XS S M L XL XXL

Marital Status:
Single Engaged Married

Parent/Guardian Name:

Home Number: Work Number: Cell Number:

Parent/Guardian Name:

Home Number: Work Number: Cell Number:

Have you attended Street Invaders before?
Yes No
If so, please state which year(s):

Are you presently dating someone?
Yes No
If so, is this person applying for Street Invaders?

Have you had alcohol or illegal drugs within the last year?
Yes No
If yes, please explain in detail:

Have you ever been involved with a cult or the occult?
Yes No
If yes, please explain in detail:

Medical History
Do you now have, or have you had a history of:
Seizures
Fainting Spells
Eating Disorder
Respiratory Problems
Psychiatric Care
Diabetes Care
Self Harm
Other

If you have checked any of these boxes or have any other relevant health concerns, please explain in detail:

Please provide us with the name and contact details of your pastor or youth pastor. Be sure to let them know that we will be contacting them to obtain a reference for your involvement with the Street Invaders Program.

Pastor's Name:

Home Phone: Email Address:

Church Name: Church Address:

Church Phone: Church Fax:

Have you spoken to your pastor about your possible involvement with Street Invaders?
Yes No

If so, does your pastor support your involvement in Street Invaders?
Yes No

When did you accept Christ as your saviour?

How did you find out about Street Invaders?

Are you currently involved in your home church or another ministry?
Yes No

If yes, please let us know what you are doing below.

Please attach your RECENT PICTURE in JPG format (.jpg):

If you are under the age of 18, you and your parents will need to sign a Parental Release Form.
Please speak with your pastor about your possible involvement with Street Invaders and have them complete a Pastoral Reference Form
Please pay online, by phone or mail for your registration fee of $50.00 for the program, (as well as the flight confirmation fee of $450.00 for all international teams)
A late fee of $25.00 must be included with all applications received after June 15th
Once we have received all of the above, we will process your application and let you know if you have been admitted into the program.

Please attach your TESTIMONY:

Street Invaders
8, 3530 11A Street NE
Calgary, AB T2E 6M7
Voice - 403.717.0707 | Fax - 403.717.0709 | Toll-free - 877.356.0707
E-mail: office@streetinvaders.ca | Website: www.streetinvaders.ca