Mission Trip Participation Application

First Name^*

Last Name^*

Address

Address Line 1

Address Line 2

City

State or Region

Country

Zip

Email^*

Enter email again^*

Church You Attend?^*

If you are a staff member please list your position

Are you a Christian?^*

Yes
No
Not Sure

If yes, have you followed through with that decision in believer’s baptism?

Are you comfortable leading someone in the plan of salvation?^*

Have you had any witnessing training?^*

Have you ever had the opportunity to lead someone to Christ?^*

Please explain why you would like to go on this trip:^*

Passport Number^*

Expiration Date^*

Place of Issue^*

Name (as It Appears on Passport)^*

Gender^*

Male
Female

DOB^*

Marital Status^*

Spouse’s Name & Phone

Emergency Contact Name & Phone^*

I acknowledge that as a MISSIONARY I will be responsible for representing Jesus at all times. I will be expected to participate in all scheduled activities during the mission trip, have a positive attitude, and show selflessness.

Participant Signature:^*

Date^*

PARENT/GUARDIAN CONSENT FOR MINORS As the parent or legal guardian of my child,

Minor’s Name

I hereby consent for my child to attend and participate in all activities on this mission trip.

Parent/Guardian Signature (for minor):

Date

Select a payment method^*