Thanks for being willing to serve as a caregiver! Before you begin, it may be helpful to collect some information for those you will be listing as references. You will be asked for the name, email address and phone number of your parents, pastor, youth pastor (If available) employer (If available) and a friend.Full Name* First Name Last Name Email (personal)* Phone Number*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Birth* MM slash DD slash YYYY Gender*MaleFemalePlease attach a picture of yourselfMax. file size: 2 GB.Occupation* Highest level of education completed* Membership: Church name* Conference/Affiliation* Marital Status*SingleDatingEngagedMarriedWidowedSpouse First Name Last Name Who will you be helping at LTO?* What time frame will you be able to serve as a caregiver?* Which LTO would you be attending as a caregiver? Spring 2023 Summer 2023 Fall 2023 Spring 2024 Reference Form: ParentsPARENTS* Names Last Name Email (Parents)* Enter Email Confirm Email Important: make sure email is correct. Reference form is automatically sent to this address.Phone Number*Reference Form: PastorPASTOR* First Name Last Name Email (Pastor)* Enter Email Confirm Email Important: make sure email is correct. Reference form is automatically sent to this address.Phone Number*Reference Form: Youth PastorYOUTH PASTOR (required when available) First Name Last Name Email (youth pastor) Enter Email Confirm Email Important: make sure email is correct. Reference form is automatically sent to this address.Phone NumberReference Form: EmployerEMPLOYER (required when available) First Name Last Name Email Enter Email Confirm Email Important: make sure email is correct. Reference form is automatically sent to this address.Phone NumberReference Form: FriendFRIEND* First Name Last Name Email (friend)* Enter Email Confirm Email Phone Number*NOTES: 1. Only click "Submit Form" once. Submission may take a few minutes depending on the file size of your profile picture. 2. When you click "Submit Form", a reference form will automatically be emailed to the references you listed above. Please ensure that the email addresses you provided are correct and current. 3. After clicking "Submit Form", you will be directed to Step 2: Childcare Application. If you have questions or technical difficulties, feel free to call Jesse Slabaugh at 717-715-2030.HiddenRecord Type Childcare (Hidden Field) HiddenApplication StatusInquiringApplyingRegisteredInterviewingSchedule ConfirmedTentativeCompleteApprovedConfirmedWaiting ListConverted to ContactLink Students To WOW EventCompletedTerminatedConverted to Lead Δ