Junior Chaplain Application

JUNIOR CHAPLAIN APPLICATION

Junior Information(Required)

First Name Last Name

Address(Required)

Street Address Street Address Line 2 City State / Province Postal / Zip Code

Home Phone #(Required)

Junior Cell #

Junior Email Address(Required)

Date of Birth(Required)

School Grade(Required)

Name of School(Required)

Custodial Care(Required)

Both parents

Mother/caregiver only

Father/caregiver only

Other

PARENT/CAREGIVER INFORMATION

Parent/Caregiver (1) Name:(Required)

First Name Last Name

Address(Required)

Street Address Street Address Line 2 City State / Province Postal / Zip Code

Home Phone #(Required)

Cell #(Required)

Employer(Required)

Title/Occupation(Required)

Date of Birth(Required)

Email(Required)

Parent/Caregiver (2) Name:

First Name Last Name

Address

Street Address Street Address Line 2 City State / Province Postal / Zip Code

Home Phone #

Cell #

Employer

Title/Occupation

Date of Birth

PROMISE & LAW

When making the junior Promise, you may substitute wording appropriate to their own spiritual beliefs for the word of "GOD"

THE USCC JUNIOR CHAPLAIN PROGRAM PROMISE;

ON MY HONOR, I WILL PUT MY BEST EFFORT:

TO SERVE GOD AND MY COUNTRY,

TO HELP PEOPLE AT ALL TIMES,

AND TO LIVE BY THE USCC JUNIOR CHAPLAIN PROGRAM LAW.

THE USCC JUNIOR CHAPLAIN PROGRAM LAW:

I WILL WILL PUT MY BEST EFFORT;

TO BE HONEST AND FAIR,

FRIENDLY AND HELPFUL,

CONSIDERATE AND CARING,

COURAGEOUS AND STRONG,

AND RESPONSABLE FOR WHAT I SAY AND DO,

AND TO RESPECT MYSELF AND OTHERS,

RESPECT AUTHORITY,

USE RESOURCES WISELY,

MAKE THE WORLD A BETTER PLACE,

AND BE OF SUPPORT TO ALL MY FREINDS AND JUNIOR CHAPLAINS.

I, THE REGISTRANT, ACCEPT AND WILL ABIDE BY THE JUNIOR CHAPLAIN PROGRAM PROMISE AND LAW.(Required)

I AGREE

Write your name(Required)

Date(Required)

Junior Chap Applicant - Upload a copy of official ID (passport or photo ID)(Required)

Drop files here or

Max. file size: 512 MB.

Junior Chap Applicant - Upload photo (portrait with white solid background. Can be taken with a smart phone. Similar to your passport photo)(Required)

Drop files here or

Max. file size: 512 MB.

Junior Chap Applicant Signature(Required)

SIGNATURE OF PARENT/CAREGIVER

Date(Required)

PARENT/CAREGIVER SIGNATURE(Required)

JUNIOR CHAP ENROLLMENT FEE

$101

PROMO CODE

PAYMENT INFORMATION

CC#

Expiration Date

Security Code

Name On Card

Billing Address

Street Address Address Line 2 City State ZIP / Postal Code

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