Mission Trip Application

Your name *

Last name

Email address *

Location of the trip for which you are applying. *

Personal Information

Full Name as it appears on your passport *

Address *

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

Phone number *

Phone type

Birthdate *

Marital status

Gender *

Country of Birth *

Current Nationality *

Passport Information

Passport Number *

Passport Expiration Date *

Place of Issue *

Emergency Contacts *

2 Contacts - Name, Relationship, Home Phone, Cell Phone

Beneficiary *

Name & Relationship

Medical Questions

Health Insurance Company *

Policy Number

Phone Number *

Current Medications & Doses

Prescription & Non-Prescription

Current Medical, Physical, or Other Problems

Serious Illnesses or Operations in the last 12 months

Imunizations in the last 10 Years

Date of Last Tetanus Shot

Please List Food Allergies (food, insect, drugs, plants, etc.)

Have you ever had any of the following conditions?

Asthma

Brochitis

Cancer

Sinusitis

Dizziness

Heart

Kidneys

Sleep Walking

Stomach

Diabetes

Other

Please explain any of the above

Occupational Skills Questions

Occupation

Special Skills

Foreign Language

Spiritual Life

Where are you a church member?

Which Life Group/Small Group/Sunday School Class are you a member of?

What other ministries do you participate in?

Have you ever served as a short-term (2 days - 6 weeks) or a long term (more than 6 weeks) missionary?

If yes, please explain.

Briefly share your salvation testimony. *

Various cultures hold different attitudes toward certain behaviors. Do you agree to follow the guidance of national Christian leaders in matters such as appropriate attire, touching between the sexes, dancing, use of tobacco, etc.? *

Electronic Signature

Electronic Signature *

Please understand that by signing these documents, you will be submitting to a code of conduct that befits a Christian representing Christ and First Baptist Church Haughton. Behavior that is not respectful to the team leader and to authority or to team members will result in termination of your participation of this and future mission trips. Authorization: "I certify the facts contained in this application are true and complete to the best of my knowledge. I also authorize the use of any information in this application to verify my statements. I also release the information in this application to the trip Team Leader(s) and the FBCH Missions Committee."

Date of Signature *

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First Baptist Church Haughton
info@fbchaughton.org
318-949-2441