Brotherhood of Christ Community
Visitor Registration
We are glad to send you this application form and we are always glad to receive visitors. We enjoy meeting new people and look forward to hearing back from you. The answers you provide on this form are important to us in determining the scope of your visit and developing a relationship with you. Your answers will not be shared with others.
Date: __________________________
Name (first, middle, last) __________________________________________
Date of Birth _____________________ SS#_________________ Passport#________________ Are you a U.S. citizen? ___________
(If you do not want to give your SS# please contact our office to discuss)
Do you have any criminal record? If so explain:_______________________________________________
Do you have any history of mental illness? If so explain: ________________________________________
Do you have any history of anger issues? Explain: _____________________________________________
Have you ever lived in a community before? If so, which one(s): __________________________________
Do you smoke or use recreational drugs (including alcohol)? _____________________________________
Marital Status: Single, Married, Single Parent, Separated/Divorced
Do you have any custody related issues for any children that may be living with you? __________________
Do you have any specialized skills that may contribute to community? ______________________________
_______________________________________________________________________________________
Current Address: Street___________________________
City _____________________ State _________ Zip ______________
Previous address: Street___________________________ Phone ___________________
City _____________________ State _________ Zip ______________
Name of emergency contact person ________________________________________________
Their relationship to you _________________________________________________________
Phone number or email where they can be reached ____________________________________
If you are under 50 years of age, please fill out the following:
Mother’s Name ________________________________ Phone ____________________________
Father’s Name _________________________________ Phone ____________________________
Do you currently have health insurance? Yes/No
Do you have any physical limitations or restrictions that would inhibit you from working on the farm here? _______________________________________________________________________________________
Please list any medical needs, food allergies, health issues or medications that we should be aware of:
______________________________________________________________________________________________________________________________________________________________________________
If you plan to drive your own vehicle to visit please fill out the following:
Make ___________________ Model __________________ Year ______ License plate State and number _______________
Please list at least two character references (family, friend, co-worker) different from the above contact person who can vouch for you:
1. _______________________________________ phone number _______________________
2. _______________________________________ phone number _______________________
What is your religious background? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Please tell us your main interest in visiting our Community: (use as much space as you need ) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
How long of a visit are you looking for? 3-4 days or 6-7 days
What dates are you proposing as a desirable time to visit? _________________________________________
(We may not accept visitors from April 1 – June 1)
Please consider the weather in Iowa, and your readiness for it, when choosing your visit dates. Also, please be aware of our dress code when you plan your wardrobe. We dress very modestly here, and while we do not expect visitors to dress just like us, we would appreciate the consideration of modest clothing while visitors are here. We prefer ladies to not wear tight pants or shorts, low cut tops, or short skirts. We ask that men always wear shirts, even when it is hot weather. Also be aware that all visitors are required to sign a liability release form upon arrival in our Community. Thank you.
Please make sure you indicate how many people are wanting to come in your group, including children, and have each adult fill out a Registration Form. Thank you.
Please list any other information that you feel is important for us to know about you: