Cross Bayou - Walk to Emmaus                                

Request for Reservation
FILL OUT THIS INFORMATION, AND CLICK SUBMIT
Walk Requested    1st  Choice Date     Walk #   Can you attend on short notice?
                             2nd Choice Date      Walk #           yes    No
First name          Last name   Initial 
Address             Address 
City                      State                     Zip

I am a Male  Female         
I am Single Divorced  Widowed Married (My spouse's name is  )
Home Phone           Business            Cell 
E-Mail               
Occupation         Employer 
Your Church        Church Address 
Has the Walk to Emmaus been explained to you, including post-walk follow up?   yes    No
Name, address, phone # of someone to contact in case of emergency and/or who can help us contact you prior to your walk.
Name   Address  Phone

 
HEALTH RELEASE FORM TO BE COMPLETED BY APPLICANT
List all allergies, medications being taken, medical problems, special diets, physical handicaps, or other pertinent information that may affect your attendance and well being at your Walk to Emmaus weekend.
In the event of an emergency, and if my closest relative and/or spouse cannot be reached by telephone, the Emmaus staff has my permission to gain the services of licensed medical professionals to provide the care deemed necessary, including anesthesia, for my well being.

Your signature                                                                            Date                                          


Register ONLY IF YOU INTEND TO BE PRESENT FOR THE ENTIRE WEEKEND.  Sponsor should already have been on a Walk to Emmaus, Cursillo, Chrysalis, Journey, Kairos, or Tres Dias. 

No reservation will be accepted without the following items:
(1) Completed and signed application,  (2) Completed sponsor's form, (3) Payment in FULL ($120).

Make checks payable to Cross Bayou Emmaus Community

REMEMBER: Return your completed and signed application along with payment in full to your Sponsor.


What size T-shirt do you prefer?  S      M       L       XL      XXL       XXXL



Your signature                                                Your Pastor's signature                                                 


Sponsor's signature                                                     Sponsor's name

TO BE COMPLETED BY SPONSOR

Sponsoring a candidate is both a joy and a responsibility.  There are things you must do for your candidate before, during, and after the weekend.  Remember also that the Walk to Emmaus is not structured to solve deep-seated personal problems.  It is designed to provide to those attending, a personal encounter with Jesus Christ.
Sponsor's Address:   
Home Phone        Work Phone 
Email Address 
Name / Denomination of the church you attend 
What Community sponsored your Walk to Emmaus?   When 
Where?   Walk #   Currently in Reunion Group?  yes  no
Which Group?    Meeting time?   Location?
Does candidate have the physical/mental health for a Walk to Emmaus weekend?  yes  no
Is candidate under any emotional strain?  Should his/her weekend be postponed?  yes  no
Will you Pray for your Candidate?  yes  no
Bring your candidate to the Walk?  yes  no
Sign up for the prayer vigil?  yes  no
Attend all the weekend community events?  yes  no
Serve and sacrifice for your candidate's weekend?  yes  no
Help your candidate get into a reunion group?  yes  no
Explain the monthly community gathering to your candidate?  yes  no
Accompany your candidate to the community gathering?  yes  no
Discuss Emmaus with their spouse?  yes  no
Care for their spouse and family during your candidate's weekend?  yes  no
Maintain minimal contact with your candidate during the weekend?  yes  no

CONFIDENTIAL INFORMATION FOR THE LAY AND/OR SPIRITUAL DIRECTOR:

Why did you sponsor this person for a Walk to Emmaus?


Describe your candidate's spiritual needs during their Walk:


Describe your candidate's personality, spiritual growth, etc. to assist the team in seating, room assignment, etc.

Please attach payment for your pilgrim's weekend: $120.00 plus $12.00 for their T-shirt and $5.00 for their red nametag.
Signature:                                                                                     Date:                            

Mail to:  Barb Fuller - 3524 Lanell Dr    Bossier City, LA 71112  (318)742-2423 / 429-2337
 after form has been filled in    clear all fields and start over