Live God Loud Ministries
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LifeTraks Student Application
Birth Date (MM/DD/YYYY)
Father's Full Name
Father's Phone Number
Father's Email Address
Mother's Full Name
Mother's Phone Number
Mother's Email Address
The student applicant agrees to commit to LifeTraks, agrees to honor and abide by all program rules, and agrees to respect program leadership at all times.
The parent gives permission for the student to attend LifeTraks and understands that the student must abide by all program rules, and agrees to respect program leadership at all times. Any inappropriate activities by the student may result in dismissal.
Electronic Signature of Student (Type your name)
Electronic Signature of Parent (Type your name)
Click the green "Send Message" button to submit your application.
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Applicants must submit the Student Application and a letter of reference from their pastor in order to complete their application. Letters can be emailed to Pastor Dan Coy at the email address below.
Additionally, parental engagement/communication via email or phone conversation is required before the interview.
Pastor Dan Coy
Crossroads Church Circleville
5679 Tarlton Road
Circleville, OH 43113
5679 Tarlton Road Circleville, OH 43113