“Loving Jesus and Sharing His Love”

Doulos/Staff Application 2017

Doulos Sessions � June 11th – June 23rd Please Include a Picture of yourself � June 25th - July 7th Please Call if you have any questions. � July 8th – July 21st Scan and e-mail or Mail to us. � July 22-Aug 4th mike@ydionline.org

Over 18? Doulos Staff Dates Available to Serve ___________ to ___________

Name: _________________________________________________ � Male � Female

Address:________________________________________________________________

City/State/Zip: ___________________________ Home Phone: _____-______-_________

Email Address: _____________________________ Cell Phone: _____-______-_________

Date of Birth:_________ Age _____ Grade______

Have you participated in the Doulos Program or Summer Staff before? �Yes � No Dates:_____________________________ � Check here to be placed on our mailing list

Personal Info (Please Print)

1. Name of Church/Fellowship that you attend:

__________________________________________________________________

2. Pastor’s & Youth Pastor’s Names & Phone Numbers:

__________________________________________________________________

3. Personal Reference Name & Phone:

__________________________________________________________________

4. Write out your personal testimony.

After we receive your application, we will contact you by phone. Please e-mail if you have any

questions about the process.

www.ydionline.org 117 Sparrow Lane, Head Waters, VA 24442 540-396-4823

Session Dates Summer 2017

Applicant Info (please print)