LEAD222 CT REGISTRATION



PERSONAL INFORMATION

Name:*
Address:*
Country:*
Cell Phone:*
-
E-mail:*
Birth Date (mm/dd/yyyy):*
Facebook Page:

(copy and paste your facebook url)

What time zone are you in:

FAMILY INFORMATION

Are you married or single:*
When were you married (mm/dd/yyyy):
Spouse's Name:
Spouse's E-mail:
Spouse's Cell Phone:
-
How many kids do you have and their ages:

MINISTRY POSITION INFORMATION

Position/Title:*
Area of ministry responsibility:
(Check all that apply)
What year did you begin working in ministry:*
What is the average weekly participation in your area of ministry:*
What year did you begin working at your current church:*
What is the name of the person that referred you to LEAD222
(if you don't know, where did you hear about LEAD222):
*

CHURCH/MINISTRY INFORMATION

Church/MInistry Name:*
Church/Ministry Address:*
Church/Ministry Country:*
Church/MInistry Phone:*
-
Senior Pastor/Supervisor Name:*
Senior Pastor/Supervisor E-mail:*
Church/Ministry Size:*
Church/Ministry Website:
Church/Ministry Denomination:*

PLEASE UPLOAD A HEADSHOT OF YOURSELF

Choose File(s):

COACH IN TRAINING

 I have read an am in agreement with LEAD222's Doctrinal Statement and confirm the following commitments:

  • Receive your ministry supervisor's approval to be trained & serve as a coach in LEAD222.
  • I will be asked to pay a $25 admin fee with this form.
  • After completing the CT training, take part in one of our “Coaching Clinic” training events.
  • Be willing to coach 1 or 2 new CTs for 9 months when you become a Coach. (Sept-May &/or Jan-Aug).
  • Recommend two other youth pastors to become CT's next season.
By checking the box below, you are stating that you agree with all five of the above statements

Disclaimer of Confidentiality/Release of Liability

I understand that LEAD222 is not professional counseling, and have voluntarily sought coaching and mentoring advice, encouragement and prayer on my own initiative. I am under no obligation to accept or reject any of the advice I may receive from the LEAD222 Coaching Team or staff from the LEAD222 ministry. With the intent to bind my heirs, relatives, legal representatives and assigns, I expressly release and hold harmless LEAD222 United, LTD, employees and all other persons working with them, including contract hires, on their behalf from liability, loss damage, claims, actions or judgment of any kind which may arise in connection with the advice received.
All services and information obtained are kept confidential (unless otherwise specified) and cannot be released without your permission. You need to know, however, there are special situations under which confidential information could legally be revealed such as:


1. In the case of emergency where you are a danger to yourself or someone else

2. If an unreported felony has occurred

3. In special circumstances where a court may subpoena your records and order a LEAD222 Coach or staff member to give testimony in a court hearing.


By checking this box I agree that I have read this Acknowledgement Disclaimer of Confidentiality/Release of Liability and understand I have executed it as my free and voluntary act.

Click Here - To read the LEAD222 Doctrinal Statement

I acknowledge this confidentiality/release of liability and agree with the LEAD222 Doctrinal statement:*