Thank you for your interest in Flight36! Please complete the form and a Flight36 staff member will contact you to schedule an appointment to review your application and to answer any questions about our program.

* Application will be reviewed by the Flight36 Advisory Board.



         
 
Son's Name:
Date of Birth:
  
 
Mother's Name:
Date of Birth:
  
 
   
   
 
Address:
  
Home Phone:
  
 
City:
  
Cell Phone:
  
 
State:
  
Work Phone:
  
 
Zip Code:
  
Mother's Email:
  
 
   
   
 
   
   
  Church Attending:   Accepted Christ:  
  Pastor's Name:   Been Baptised:  
  Pastor's Phone:   Attends Youth:  
             
  Son's School Name:   Doctor's Name:  
  Teacher's Name:   Doctor's Phone:  
  Teacher's Phone:   Ins. Carrier:  
  Grade Average:   Policy Number:  
             
     
  Has he accepted Jesus Christ as his savior?  
     
  Does he have any learning disabilities?  
     
  List the Sports/Hobbies
that he enjoys:		  
     
  List any physical or behavioral conditions:  
     
  List any medical conditions or medications:  
     
  Briefly explain your son's strengths and talents he exhibits:  
     
  Briefly explain your son's weaknesses or character flaws he needs to work on:
  
     
  Briefly explain the relationship
with his father:		  
     
  Briefly explain what you expect your son to benefit from Flight36:  
     
 
  Please call me, I have a few questions.
  I want to receive the Fight36 Newsletter.