Apply For a Mission Trip

Destination *

Date *

Name (as printed on passport) *

Address 1 *

Address 2

City *

State *

Zip / Post Code *

Email *

Home Phone

Cell Phone

Age *

Gender *

Male
Female

Citizen of what country? *

Do you have a passport? *

Yes
No

Passport # *

Expiration Date of Passport *

Date of birth *

Marital Status *

Single
Married

Emergency Contact Name *

Emergency Contact Email

Emergency Contact Phone

Shirt Size

Have you ever served on a mission trip before or had any cross-cultural experience? *

Yes
Noe

If yes, explain.

Explain briefly why you want to participate in this mission trip *

Please list any talents you have (drama, singing, instruments, puppets, construction, medical, teaching, etc.)

If you speak any foreign languages fluently please list them here.

List any conditions you have which might affect your ability to fully function as a missionary on this trip. (i.e. fear of flying, depression, anxiety, sleeping disorder)

If you have any chronic illnesses or allergies please list them here.

Are you presently under medication prescribed by a doctor? *

Yes
No

If yes, explain

How would you describe your health and fitness? *

Have you ever been convicted of committing a crime? *

Yes
No

If yes, explain

If applying for a trip that includes ministry to children, you may be required to have a background check. Do you agree to a check? *

I have read and understand the above information. The information I have given is accurate and true to the best of my knowledge. *

What is 10 + 5? *

Apply

SHORT TERM MISSION APPLICATION

RELEASE FORMS