Apply for ROP

We are so glad you decided to apply to the ROP program! Please complete the application below. If you have any questions or concerns, please feel free to contact the Rites of Passage office at 310.330.8000 ext.3240 or email r itesofpassage@faithfamily.org.

First Name: *

Middle Name:

Last Name: *

Age: *

Birthday: *

Name of your siblings? (skip if you don't have siblings.):

School: *

Grade: *

What letter grades do you receive?: *

A's-B's

B's-C's

C's-D's

F's

What is your favorite subject?: *

What are your hobbies?:

What do you want to be when you grow up?: *

Name of your male role model?:

How much time do you spend with him?:

Describe what makes you happy:: *

Describe what makes you sad:: *

Describe what makes you angry:: *

Have you accepted Christ as your Lord and Savior?: *

Yes

I don't know.

Why do you want to be in the Rites of Passage?: *

ALL OF THE INFORMATION BELOW SHOULD BE FILLED OUT BY THE PARENT/GUARDIAN: *

Parent

Guardian

Parent/Guardian first name: *

Parent/Guardian last name: *

Parent/Guardian Address: *

Parent/Guardian City: *

State/Province: *

Parent/Guardian Zip:

Country: *

Parent/Guardian home phone:

Parent/Guardian cell phone: *

Parent/Guardian email address: *

Emergency contact: *

Emergency contact relationship: *

Emergency Contact Phone #: *

Parent/Guardian marital status: *

married

single

divorced

Does child's father play an active role?: *

Yes

Does child's mother play an active role?: *

Yes

Is the Parent/Guardian a member of FCBC?: *

yes

If no, what church do you attend?:

Has your son been suspended or expelled from school in the past 2 years?: *

Yes

If you answered yes to the above question, please provide a detailed explanation::

Has your child been subject to, or involved with the following?: *

	Yes	No
A therapist?
Anger, fits of rage?
Emotional outburst?
Aggressive or violent behavior?
Destructive behavior?
Drugs or alcohol use?
Gang related activity?
Self injury?
Psychotic episodes?
Matters related to juvenile court system or the police department?

If you answered yes to the above question, please provide a detailed explanation::

How would you rate your son's respect for authority?: *

High degree of respect for authority

Some respect for authority

No respect for authority

Has your son been subject to psychological, sexual, or physical abuse?: *

Yes

Why do you want your son involved in the Rites of Passage program?: *

How did you hear about the ROP program?: *

Leave this field blank:

Apply for ROP

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