Application for Short-term Missions

Trips

Which trip are you applying for?

Caribbean Brazil South Asia

Contact

Full name (as it appears on Passport)

Address, City, ST Zip

This address will receive a confirmation email

Mobile Phone

Birth Date

Do You Have a Passport

Yes Applied for

Passport No. and Expiration Date

Upload Image or pdf of Passport

Upload (8MB)

Family

Adult Marital Status

List names of your spouse and kids; and your kids ages

Health

Describe you overall health, level of fitness and ability to participate in physical activities

Currently under care of a physician, taking Medications?

Health Insurance Name, Phone, Group or Member ID.

Doctor Name and Phone

Emergency Contact Name, address and Phone

Secondary Emergency Contact Name, address and Phone

Beneficiary (name and relationship) to be listed on supplemental trip insurance

Testimony

Languages, skills, talents, spiritual gifts or ministry experience that will be helpful on the field?

Previous MIssions Experience?

Share your testimony here

Church Life

Church family? Name and city

Are you a member Yes No

How do you serve the church?

Please provide two references (name, phone and email). One should be a non-family member. One should be a minister or teacher in the area you serve or have served.

Commitment

I make a commitment to:

faithfully participate inpre-trip trainings raise the necessary prayer and financial support submit to the authority of the trip leader and the host on-the-field conduct myself in a manner worthy of the Lord while serving Him on the project, and refrain from any behavior which may compromise my witness.

Additionally, if at any time while on the project my behavior constitutes a problem, the team leader has the authority to ask me to return home. Any additional cost incurred as a result of this action will be at my cost. Should any illness or medical emergency be required, I agree to pay all medical expenses in excess of the amount provided by any applicable insurance policy. (please select

Yes

Statement of Faith

I have read the statement of faith presented here (bfm.sbc.net/bfm2000/) and agree with this statement:

Yes Not entirely (please provide explanation below)

Legal Waiver I understand and agree that Great Commission Partnerships Network, its staff or other representatives assume no responsibility for the loss of property, damage to the same, personal harm, illness, or loss of life, that may occur during the execution of this volunteer mission project; and I, for myself, my heirs, executor, administrators, distributes, and assigns, in consideration of my admission to volunteer service and other good and valuable considerations, do hereby absolve said Interlocking Ministries, sac and hold them harmless from any claim or demand which I or they might conceivably assert upon the basis of the foregoing. I understand that I will be under the policies of Great Commission Parternships Network and my field supervisor. I agree to abstain from the use of tobacco products, alcoholic beverages, illegal drugs, and any other behavior that would hinder Christian ministry. I understand that the breach of this contract will be cause for dismissal from the volunteer project and return home at my own expense.

I Agree

Signature

Type your full name as a signature here

Date Signed

For Students under 18, please provide parent's name, address, phone and email below:

Parent's Signature (type your full name and date here)

Payment

Will Pay Deposit by:

Check by mail or in person Online here

Deposit

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Application for Short-term Missions

Description

Please Fix the Following