Quest Date:                                                                                        Quest Center:
NAME:  Last:                                                                                     First:
Address:                                                                                            City:                                     State:             ZIP:
Email Address:
Phone:                                                                                              School:                                  Grade:
Age:          Date of Birth:                 Gender:                                         Any special dietary needs?
Parent or Guardian :
Parish:                                                                                              Pastor:
Has anyone in your family made a Quest before?   Yes___    No___
What is your personal motivation for coming on Quest?  (circle all that apply)
ENCOURAGED            PRESSURED         REQUIRED         PERSONAL CHOICE
In a few sentences answer the question "why do I want to go on a Quest?"

Parental Consent / Signature:
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Dear Friend,
   The young person who gave you this reference form has filled out an application to participate in a Quest weekend.  Quest is a 33 hour program of sharing for high school freshmen and sophomores.  It is an experience of being together with other teens so that the participants can discover more about God, themselves, and their relationships with family and friends.
   In order that the Quest team may be aware of the needs of each participant, we ask that you fill out the reference form below.  YOUR COMMENTS, OF COURSE, WILL BE KEPT CONFIDENTIAL.   We ask you to pray for this young person so that Quest might be a positive influence in his or her life.  Should you have questions or desire to know more about the Quest program, please contact the person listed below.
   Thanks very much for your help!                                                                                         Belleville Diocesan Quest

Please circle all that apply:
1. Does this person have any personal problems we should be aware of?    Drugs    Alcohol    Personality    Family    Home    Other:
2. What is this person's motivation for coming to Quest?     Encouraged      Pressured      Required      Personal      Choice     Other:
3. What is this person's relationship to peers?       Loner        Very Quiet        Disliked        Well Liked        Respected        Other:
4. Relationship in a discussion group will be: Quiet   Average Participation   Very Talkative   Domineering   Fair Discussion Leader   Good Discussion Leader
5. Maturity Level?     Very Mature                  Average                 Immature
6. From your experience, what is the quality of this person's faith?     Strong         Searching            Weak           Don't Know
7. What is your acquaintance with this person?      Distant      Average        Very Close         Professional
Comments:

Your Name:                                                                                  Phone:
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