Prayer Walk Champion Form
First Name
*
Last Name
*
Phone
*
Email
*
What city/region are you in?
Region
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Albuquerque, NM
Birmingham/Tuscaloosa, AL
Boise, ID
Central PA (Harrisburg)
Central PA (York)
Central PA (Lancaster)
Chapel Hill, NC
Charlotte, NC
Chicago, IL
Denver/Boulder, CO
Detroit, MI
Fayetteville, NC
Greenville, SC
NorCal - Antioch, CA
NorCal - Modesto
NorCal-Sacramento
NorCal - Stockton
NorCal - Walnut Creek
Northern VA
NYC
Olympia, WA
Ontario, OR
Raleigh, NC
Roanoke, VA
Seattle, WA
SoCal - High Desert
SoCal - Orange County
SoCal - Pomona
SoCal - Riverside/Corona
SoCal - San Bernardino
SoCal - San Fernando
SoCal - Santa Barbara
SoCal - Upland
SoCal - Ventura County
SoCal - Vista
South Florida
Triad, NC (Greensboro/WS)
Whatcom County, WA
None of these
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Address
*
City
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State
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Postal code
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Date of birth
*
*Volunteers under 18 must have a Youth/Minor Waiver signed by a parent/guardian before participating.
Church
*
Emergency Contact Name
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Emergency Contact Phone Number
*
How do you plan to serve?
*
Select Option
Saturday Prayer Walk Volunteer
Committed Prayer Walker
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Background Check (Saturday Prayer Walk Volunteers Only)
I consent to a background check required by Love Life USA, and upon completion of this application I will submit my background screening application (Fee of $15.95 required by applicant)
*
I agree
I have already completed a Love Life background check
I have completed a background check through my church and will send a copy to
[email protected]
Upon submission of this form, we will send you an email with the link to the background check.
I have read and agree to abide by the Prayer Walk Code of Conduct.
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Yes (Si)
I have read and agree to abide by the Confidentiality Statement.
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Yes