Application to go on Mission Trip

 

Name___________________________   Date of Birth ________________________

Address ______________________________________________________________________

Email address __________________________________________________________________

Daytime telephone __________________ Evening telephone ______________________________

Church Membership ______________________________________________________________

Your occupation _______________________________ Position _________________________

Passport number ________________________ Marital Status_____________________________

Do you sing? _________ What instruments do you play?__________________________________

Languages spoken / degree of fluency _________________________________________________

T shirt size _________ Will you trust God to provide your funds to be able to pay for this trip? ______ 

Other countries you have visited____________________________________________________

Have you read and signed the Trip Covenant? _________ Do you have any problem with the Covenant and

the promises you have to make in this covenant? ___________ If so what are your problems or disagreements?

_________________________________________________________________________

Please describe any medical condition that a doctor might need to know about on this trip!

________________________________________________________________________

What prescription medications do you take (generic name, strength, and frequency of dosage):

________________________________________________________________________

Please describe your general health condition:

_________________________________________________________________________

Please list any known allergies:

__________________________________________________________________________

Doctor's name______________________ Phone number ___________________________________

In the event of an emergency, whom should we notify?  ______________________________________

Relationship _________________________ Telephone ____________________________________