Mission Trip Application (Mission Trips)

Please select the trip for which you are applying:

First Name:

Middle Name:

Last Name:

Preferred Name:

Gender:

Please enter your date of birth in mm/dd/yyyy format:

Street Address:

Apartment #:

City:

State:

Zip Code:

Email Address:

Primary Phone #:

Secondary Phone #:

Full name EXACTLY as it appears on your passport (this must match for booking flights):

Passport #:

Passport Expiration Date:

Nationality (US citizen or other)

What airport would you like to depart from? (We use this info for booking flights)

General Health:

Please list any allergies:

Do you have special dietary needs?

Church Affiliation:

Pastor's name:

Church Phone #:

I believe that I am emotionally healthy.

I believe that I am walking in wholeness.

During the past year, have you been under the care of a licensed counselor, psychiatrist, or psychologist?

Have you ever been convicted of a misdemeanor or felony?

Please list any previous mission trip/overseas experience:

Please describe why you want to visit orphans:

Are you willing to work as a member of a team with a Christ-like attitude?

Are you willing to follow the authority of the Mission Trip Team Leader?

Will you refrain from criticizing the local culture's food, language, people, etc?

Please list any gifts and abilities you can offer the team (foreign languages, carpentry, medical skills, etc.):

Please list your emergency contact information: (Name, Relationship, Phone )

Please list your emergency contact's email address:

How did you find out about this particular trip?