Student Registration ADT 2023 Student Information ADT 2023 Advanced Discipleship Training 2023-2024 Date MM slash DD slash YYYY Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email(Required) Best Contact Phone#(Required)Date Of Birth MM slash DD slash YYYY Marital Status Single Married Divorced Widowed Separated Name of Spouse First Last Emergency Contact #1 Plus Phone # Occupation Church Member? Yes No Church Name and Denomination Christian Background and HistoryBriefly, how and when did you come to Christ?What is your goal in taking ADT?Have you recieved Discipleship counseling and/or counseling in the past?(Required) YES NO Briefly, explain your experience. Do you have Christian Ministry experience?(Required) YES NO Briefly, explain your experience. AgreementsInformation Agreement(Required) I Agree I Do Not Agree I AGREE THAT I WILL KEEP ALL PERSONAL INFORMATION ABOUT PARTICIPANTS IN ADVANCED DISCIPLESHIP TRAINING OR WOMEN OF GRACE CLASSES, AND THEIR LIKENESS, IN STRICT CONFIDENCE, WHETHER I PARTICIPATE ON THE PHYSICAL PREMISES OF GRACE LIFE INTERNATIONAL, ONLINE, OR VIA RECORDINGS. Name First Last Date MM slash DD slash YYYY Sharing Agreement(Required) I Agree I Do Not Agree I UNDERSTAND THAT ADVANCED DISCIPLESHIP TRAINING AND WOMEN OF GRACE CLASSES ARE RECORDED AND CAN BE USED BY GRACE LIFE INTERNATIONAL FOR OTHER TRAINING OR PROMOTIONAL PURPOSES. BY SIGNING BELOW, I UNDERSTAND, AND GIVE PERMISSION TO GRACE LIFE INTERNATIONAL TO SHARE VIDEOS RECORDINGS, AUDIO RECORDINGS AND/OR PICTURES OF ME IN ORDER TO SHARE GRACE LIFE TEACHINGS WITH OTHERS OR TO PROMOTE THE GRACE MESSAGE WITHOUT ANY FINANCIAL OR OTHER COMPENSATION.Name First Last
