First Name
*
Last Name
*
Email
*
Best Phone Number
*
Current State of Residence
*
Preferred Contact Method
*
Gender
Male
Female
Are you a business owner or business leader?
Yes
No
Relationship Status
Single
Married
Divorced
Separated
Widowed
Any Religious Affiliation
Your answer to this question will not disqualify you from the program.
How would you rate your marriage ?
Not Married
Bad / edge of divorce
Surviving not thriving
Roommates
Healthy but could improve
Best it has been
N/A
What is the biggest challenge you currently have in your life and business? Why?
Describe your current professional role.
Why are you interested in attending the Battleworn Legacy experience ?
How did you hear about us?
Friend
Pastor
Podcast
Facebook
Instagram
YouTube
TikTok
LinkedIn
Other
If Battleworn Legacy equips you to become a stronger man, steward your income with greater purpose, improve your health, and deepen your relationship with God, your wife, and your children, are you willing and financially able to invest in this transformational experience?
Yes
No
Need more information
What is the primary reason you are applying for the Battleworn Legacy experience at this point in your life?
What specifically are you hoping will change in your life, marriage, family, business, faith, health, or leadership as a result of this experience?
Why now?
Are you applying because you personally want to attend, or because someone else encouraged you to apply?
I personally want to attend
My spouse encouraged me
A friend referred me
A pastor or mentor encouraged me
I am unsure
Other
Are you willing to be challenged physically, mentally, spiritually, emotionally, relationally, and professionally?
Yes
No
I have concerns
I understand Battleworn Legacy is not a vacation, passive conference, therapy program, or medical program. It is a challenging, high-accountability experience designed to confront areas of weakness, build brotherhood, and push men toward growth.
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I understand and agree
I understand participation may include uncomfortable conversations, physical activity, group discussions, prayer, scripture, personal reflection, leadership challenges, and accountability.
*
I understand and agree
I understand acceptance into the program does not guarantee graduation or completion.
*
I understand and agree
I understand Battleworn Legacy will meet me where I am, but I am expected to participate fully, give honest effort, complete required activities to the best of my ability, and not quit.
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I understand and agree
I am willing to follow program rules, staff instructions, safety protocols, and the schedule provided.
*
I understand and agree
Do you currently have any medical condition, injury, disability, physical limitation, mobility issue, or health concern that could affect your ability to participate in physical activity?
Yes
No
Explain
Are you currently under the care of a physician, counselor, therapist, psychiatrist, or other care provider for any physical, emotional, mental health, or behavioral health concern?
Yes
No
Explain Care
Do you have any current or past injuries involving your back, neck, knees, shoulders, heart, lungs, brain, nervous system, or mobility?
Yes
No
Explain Injuries
Do you have any current restrictions from a doctor or medical provider regarding exercise, physical activity, lifting, running, hiking, outdoor activity, sleep, stress, or strenuous activity?
Yes
No
Explain Restriction
Are you currently taking any medications that staff should be aware of for safety, emergency, or participation reasons?
Yes
No
Explain Medications
Do you have any allergies, dietary restrictions, food sensitivities, or medical needs that Battleworn Legacy should know about?
Yes
No
Explain Allergies
Emergency Contact Name
*
Relationship
*
Emergency Contact Phone
*
Emergency Contact Email
*
In the event of a medical emergency, do you authorize Battleworn Legacy staff or representatives to contact emergency services and your listed emergency contact?
Yes
No
Have you experienced any major trauma, loss, addiction, marital crisis, business failure, legal issue, or emotionalhardship that may affect your participation?
Yes
No
Expalin Major
Are you currently struggling with alcohol abuse, drug use, pornography, gambling, anger, depression, anxiety, suicidal thoughts, or other destructive patterns?
Yes
No
Explain Struggle
Have you had thoughts of harming yourself or someone else in the last 12 months?
Yes
No
Explain Thoughts
Are there any legal, domestic, criminal, protective order, custody, substance abuse, or behavioral issues that could affect your ability to safely participate in a group environment?
Yes
No
Explain Legal
Are you willing to be honest with staff and other participants about the areas of your life where you need growth?
Yes
No
Unsure
If married, does your spouse know you are applying?
Yes
No
Not applicable
If married, is your spouse supportive of you attending?
Yes
No
Not applicable
What is one area where you believe you are currently failing to lead well?
What would your family gain if you became a healthier, stronger, more disciplined, and more spiritually grounded man?
Are you currently the owner, founder, executive, senior leader, or decision-maker in your business or organization?
Owner
Founder
CEO / President
Executive / Senior Leader
Manager
Employee
Self-employed
Other
What type of business or organization do you lead or work in?
Approximately how long have you been in business or leadership?
Less than 1 year
1-3 years
4-7 years
8-15 years
15+ years
What is your approximate annual personal or business income range?
Under $50,000
$50,000-$100,000
$100,000-$250,000
$250,000-$500,000
$500,000+
Prefer not to answer
Are you financially able to invest in a transformational men’s leadership experience if accepted?
Yes
No
Need payment plan
Need scholarship
Need more information
If accepted, who will be responsible for making the financial decision?
I am sole decision-maker
I will decide with spouse
I will decide with business partner
Need to review finances first
Other
If accepted, are you prepared to make a decision within 48 hours of your acceptance call?
Yes
No
Need more information
What attracted you most to Battleworn Legacy?
Faith
Brotherhood
Business growth
Marriage / family restoration
Physical challenge
Leadership development
Accountability
Transformation
Other
What would make this experience a clear win for you?
What would prevent you from attending if accepted?
Cost
Schedule
Travel
Spouse / family concerns
Fear or uncertainty
Physical limitations
Not ready
Other
Are you willing to get on a phone call with a Battleworn Legacy team member as part of the application review process?
Yes
No
Do you consent to receive calls, texts, and emails from Battleworn Legacy regarding your application, scheduling, payment options, and related opportunities? I understand that message and data rates may apply, message frequency may vary, and I may reply STOP to unsubscribe from text communications at any time?
*
I understand and agree
I consent to receive SMS notifications, alerts, and occasional marketing communications from Battleworn Legacy. Message frequency varies. Message and data rates may apply. Reply STOP to unsubscribe at any time.
I consent
I understand Battleworn Legacy may involve group discussions where personal stories, struggles, and sensitive information may be shared by other participants.
I understand and agree
I agree to respect the privacy and confidentiality of other participants.
I understand and agree
I agree not to record, post, share, or publicly disclose another participant’s story, statements, struggles, or personal information without permission.
I understand and agree
Are you willing to sign a participant agreement, liability waiver, media release, confidentiality agreement, and program conduct agreement before attendin
yes
No
Would like to review first
In your own words, why should Battleworn Legacy consider you for this experience?
What are you willing to fight for in this season of your life?
Is there anything else we should know before reviewing your application?
Printed Full Name
*
Date
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Signature
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Clear