Walk to Emmaus Pilgrim Application

Name (First and Last)(required)

Gender(required)

Home Address(required)

Phone Number(required)

Age at the Time of the Walk(required)

T-Shirt Size(required)

Home Church(required)

Pastor's Name and Phone Number(required)

Sponsor's Name(required)

Sponsor's Phone Number(required)

Do you have any food or environmental allergies? If so, please explain.(required)

Do you have any medical/physical needs that would require you to be on a bottom bunk or need a golf cart to get from the Bliss Center to the Church during the weekend? If so, please explain below.(required)