2008 Trip Applying For: Please Check One
Nashville Trip • June 21-29, Guys & Girls (Ages 13-18)
Nashville Trip • July 19-27, Guys & Girls (Ages 13-18)

Participating as a: Please Check One
Player Ministry Teammate (non-player) Local Resident - Player/Teammate

Please Update the following information:

Personal Information
Name (as written on birth certificate):

Name you prefer (nickname):   Date of Birth:  (mm/dd/yy)

Email Address:

Home Street Address:

City:   State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Zip:

Phone #:   Fax #:

College Street Address (if applicable):

City:   State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Zip:

Phone #:   College Email Address:

Social Security Number   Citizen of what country:

Do you have a valid passport?   Yes No

Passport #:   Expiration Date:  (mm/dd/yy)

Age:   Height:   Weight:    Male Female

Parents/Guardians Names:

Address (if different from above):

References

Youth Pastor or Pastor:   Church Name:

Church Address:

City:   State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Zip:

Phone #:   Fax #:

Email Address:

Coach:   Team Name:

Street Address:

City:   State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Zip:

Phone #:   Fax #:

Email Address:

Since traveling with UGM, have you:

Been involved with alcohol, illegal drugs, a cult or the occult, within the past year?
Yes No
Been expelled from school, served in a juvenile detention center or jail?
Yes No

If the answer to any of the above questions is yes, please explain.

Are you still active in your church and/or youth group?
Yes No
Are you still growing and being discipled in your walk with God?
Yes No
Do your parents/legal guardians still support your traveling with UGM?
Yes No

If the answer to any of the above questions is yes, please explain.

Have you been active in playing soccer since last traveling with Ultimate Goal?
Yes No

Help us by listing a few Christian players you would recommend for one of our outreaches. Please give us their contact information (name, address, phone, fax, & e-mail).

Prayer and Financial Support

Home Church:   How long have you attended there?:

Would your church support you financially and through prayer?
Yes No Maybe

Are your parents willing to support you in prayer and finances?
Yes No Maybe

If you are unable to raise the full trip amount through donations, are you able to guarantee the amount needed?
Yes No  I can pay up to $

Once we receive and approve your player application, we will contact you about getting your $200 deposit (only $75 for U.S. Outreaches) and a recent photo. Also, once the recommendation form from your pastor is received and approved, we will notify you of your acceptance.

Pastor's Contact Information

Name:

Email Address:

Phone #:

 

Coach's Contact Information

Name:

Email Address:

Phone #: