Name_____________________________________________________ Age _________

Address_________________________________________________________________

City__________________________________________ State_______ Zip___________

Phone______________________________Cell _________________________________

E-mail:__________________________________________________________________

Please answer the following questions to help us match you with blind campers.

1. Have you had any experience working with the blind? If so, please explain briefly.

_______________________________________________________________________

_______________________________________________________________________

2. In your own words, explain, "What is a Christian?"____________________________

________________________________________________________________________

________________________________________________________________________

3. Where do you attend church? _____________________________________________

4. Please list any special talents and/or abilities _________________________________

________________________________________________________________________

Please return this completed form by Apr. 15, 2007 to:
Bro. George Gray
Circle of Love
5028 S. Duck Creek Rd.
Cleveland, TX 77328