Student ApplicatiOn PROGRAM Students must be at least 13 years of age by July 15 of the program year in order to apply for Street Invaders. What program are you applying for? * Select all/any that apply REGIONAL MISSION: Regina, SK: August 3- 17, 2025 ($525) MISSION TRAINING ONLY: Regina, SK: August 3-9, 2025 ($425) REGIONAL MISSION: Surrey, BC: August 10-24, 2025 ($525) MISSION TRAINING ONLY: Surrey, BC: August 10-15, 2025 ($425) PERSONAL DETAILS Full Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Cell Phone Number * (###) ### #### Email * Date of Birth * MM DD YYYY Gender * Male Female Shirt Size * S M L XL XXL XXXL Have you attended Street Invaders before? * Yes No If yes, which years have you attended Street Invaders? How did you hear about Street Invaders? * Are you currently dating someone? * Yes No If yes, are they attending Street Invaders? Yes No Have you had alcohol, cannabis, or illegal drugs in the last year? * Yes No If yes, please explain in detail PARENT/LEGAL GUARDIAN EMERGENCY CONTACT We require the contact information for one parent or guardian. Primary Contact Parent/Legal Guardian #1 Full Name * First Name Last Name Relationship to Student * Email * Cell Phone Number * (###) ### #### Secondary Phone Number (###) ### #### Secondary Contact Parent/Legal Guardian/Other #2 Full Name * First Name Last Name Relationship to Student * Email * Cell Phone Number * (###) ### #### Secondary Phone Number (###) ### #### MEDICAL DETAILS Health Card Number * Health Card Province * Do you have any history of the following: Seizures Fainting Spells Eating Disorders Respiratory Problems Mental Health Issues Self-Harm Allergies Other If Other was chosen, please specify here CHURCH DETAILS Please provide us with the contact details of your pastor or youth pastor. Let them know that we may be contacting them about their reference for your involvement with Street Invaders. Church Name * Church Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Church Phone Number (###) ### #### Office Email * PASTORAL REFERENCE Please provide us with the name of a youth pastor/another pastor for a reference that can speak to your qualifications for this position. Once you submit your application, Street Invaders will automatically send a pastoral reference request to the person you list. Note: your reference cannot be a family member. Youth Pastor or Other Pastor's Name * First Name Last Name Pastor's Email * Pastor's Cell Phone Number * (###) ### #### Have you spoken to your reference about your involvement with Street Invaders? * Yes No If yes, does he or she support your involvement with Street Invaders? Yes No Are you currently involved in your home church or another ministry? * Yes No If yes, please explain your involvement TESTIMONY 1. Have you accepted Jesus into your life? Tell us a bit about that. * 2. What are some of the biggest obstacles you have faced? Tell about how you overcame/are overcoming them? * 3. Why do you want to come to Street Invaders this year? * 4. Do you have any additional comments or anything else you want us to know regarding your application? Do you agree to the terms stated below? * The purpose of Street Invaders is to minister the gospel of Jesus Christ. Street Invaders requires strict compliance with rules and regulations including rules concerning conduct, dress, and Christian lifestyle. We still expect these standards to be followed during online and in-person meetings. Failure by students, team members, leaders, or staff to comply with Street Invaders policy is grounds for dismissal, without refund or reimbursement. Yes, I agree to the terms of the Student Agreement. PARENT/GUARDIAN AGREEMENT Since you are under the age of 18, your parent(s)/guardian will need to sign the below document. LIABILITY AGREEMENT - PARENT SIGNATURE NEEDED * By checking this box I certify that this document has been signed by the legal parent or guardian. CODE OF CONDUCT AGREEMENT By checking this box I certify that this form has been signed by the student/applicant Thank you for your application, you can expect to hear from us shortly!
