Mission Trip Application

Trip Information

Destination

Trip Date*

Personal Information

Name (as it is on your passport)*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Email*

Date of Birth*

Emergency Contact Name*

Emergency Contact Phone*

Passport Number*

Expiration Date*

Are you a member of Sevier Heights?*

If so, when did you join?

If not, to what church do you belong?

Do you need to have financial assistance from the church?*

What allergies or other chronic health conditions do you have? (If these are controlled with medications, please indicate those.)*

Please write out your personal testimony. Include your salvation experience, as you might share it with a lost, unchurched person. Also describe what the Lord has been doing in your life recently.*

By submitting this form, you agree with the following:

I understand that being in a foreign culture, it is imperative that I follow the instructions of the trip leader promptly and fully. I release the team leader, fellow team members and Sevier Heights Baptist Church from any liability resulting from my voluntary participation in this endeavor. In the event of a medical emergency, I give permission for the team leaders to provide or secure medical care as needing for my well being at my expense.

Trip Information

Personal Information

By submitting this form, you agree with the following:

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