Pilgrim Application

Pilgrim Application | Applicant Information

Name(Required)

First Last

Preferred Name

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Marital Status(Required)

If married, has your spouse ever attended Walk to Emmaus? If so, where and when?

Age(Required)

Name and denomination of your church(Required)

Pastor’s name(Required)

How long have you been involved in your church? In what ways are you involved?(Required)

Health Information

Do you have any special needs such as medical conditions, dietary restrictions, or other needs we should be aware of?(Required)

If yes, what are your needs?

Do you have any physical restrictions that prevent you from climbing stairs?(Required)

Are you a smoker/vaper? (used for roommate placement)?(Required)

Emergency Contact (other than spouse). Please include name and telephone number.(Required)

Preparation and Cost

You must be sponsored by someone who has completed a Walk to Emmaus, Cursillo, Tres Dias or similar 3-day weekend. Has the Walk to Emmaus been fully explained to you?(Required)

Briefly explain why you wan to attend Walk to Emmaus and what you hope to gain from the walk.(Required)

We require a registration deposit of $50.00 that may be made electronically. Electronic options are Venmo or CashApp to email address southmsemmaus@gmail.com. This will be applied toward your contribution of $220.00 which partially offsets the expenses of your weekend. The deposit is non refundable. If paying electronically, please indicate which app you will use and from which email address the payment will come from.

Elecronic Signature: By typing you full name below, you acknowledge: The Walk to Emmaus weekend begins on Thursday evening at 6 P. M. and ends on Sunday evening. You will pray, sing, worship, and study with other “Pilgrims” on the road to Emmaus. Because our world is full of distractions - cell phones, watches, alarm clocks, pagers, electronic games, computers, and radios need to be left at home during the weekend. Your sponsor will act as a point of contact in the event of an emergency.(Required)