Trip Registration Form

PAGE 1

First Name:

Address: City: State: Zip:

PAGE 2

Email:

Occupation:

Are you Single or Married?

Do you have Children?

Please list your interests, hobbies, and skills below(even if they seem unrelated to this trip):

Have you ever traveled outside of the U.S?

Have you ever been on a mission trip?

PAGE 3

Passport Information:

Do you have a valid passport?

Please write full name as it appears on your passport:

Surename:

Given Names:

Nationality:

Passport Number:

Date of Expiration:

Month: Day: Year:

PAGE 4 Please list any health problems:

Do you speak French/Creole?

Church Affiliation: (if Applicable)

Name of Local Church:

Name of Pastor:

City: State:

What ministries are you involved in?

What is your experience with children's Ministry? What are your Skills and Interests?

What do you think it means to be a Christian?

Please share your personal testimony.

PAGE 5

Specialized ministry skills and talents:

Drama Music Organization Art and/or Crafting Teaching Balloons and Puppetry

Other:

Why do you want to go on this trip?

In your opinion, what are your strengths?

In your opinion, what are your weaknesses?

What do you think will be your biggest challenge on this trip?

Are you willing to raise the funds needed to cover the cost of the trip and meet payment deadlines?

On the mission field, do you agree not to use alcohol, tobacco, public displays of affection between sexes (married or single), profane language, inappropriate dress deemed disrespectful of the culture you are serving in, and/or critical or complaining attitude or words?

Do you agree to remain with the group at all times and follow the instructions of the leaders?

I am willing to follow the above guidelines even if I might not totally agree with them in every situation.

Type Your Full Name as an Electronic Signature: Date:

I understand that it is my responsibility to check with my physician concerning immunizations.

I understand that if unexpected events happen it is possible that I will have to pay an additional amount to help cover the added expense (such as delayed flights or unexpected travel expenses).

PAGE 6

Emergency Contact Information:

Who may we contact in case of an emergency?

First Name: Last Name:

Relationship to Applicant:

Address:

City:

State:

Zip:

Phone:

Email:

PAGE 7

I hereby certify that all statements in this application are true and complete to the best of my knowledge.

Type Your Full Name as an Electronic Signature: Date:

Character References

Reference 1: First Name: Last Name: Email: Number:

Reference 2: First Name: Last Name: Email: Number:

Reference 3: First Name: Last Name: Email: Number: