To apply for one of our mission trips, please fill out the form below: Name as appears on Passport * First Name Last Name Gender Birthday Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone Work Phone Cell Phone Marital Status Do you have any children living at home? Are you a member of Word Baptist Church If you are a member of another church, please indicate the name of the church you are a member of.: What life group do you attend? Do you have a current passport? What is your passport number? Does your passport expire during this trip? Name of Mission Trip Mission Trip Dates Location of Mission Trip Personal Reference Please list a personal reference along with their e-mail address. Have you previously filled out a Word Baptist Church Mission Application in the past 12 months? Emergency Contact Please include your relationship to the contact, a name, address, phone number, work phone number and e-mail address. Name of your Health Insurance Provider ID# Group# Name of Policy Holder Employer Beneficiary Relationship to you: Health Description Blood Type Are you currently taking any medication? If yes, please list all medications you are currently taking. Do you have any allergies? (i.e. animals, plant, food, medicine)? If yes, please list all allergies. Please list your current innoculations and date received (i.e. Hepatitus A/B, Yellow Fever, Tetanus, Typhoid.) Have you been under the care of a physician, counselor, or mental health professional in the last 12 months? If yes, please briefly explain. Write out briefly in your own words how a person can become saved. Write out your salvation story, including when you were baptized. How are you currently growing in your relationship with Christ (emphasizing your prayer life and Bible study/quiet time.) Give a brief explanation of how you know God wants you to be on this project. Excluding minor traffic violations, have you ever been convicted of any violation of any law or ordinance? Do you have any physical impairment that prevents you from physical work? Are you living a lifestyle of a pre-marital, extra-marital or homosexual relationship? Do you completely abstain from use of alcohol, illegal drugs and tobacco products? Do you have a daily prayer and Bible study time? Are you willing to be involved in the visitation outreach of Word Baptist Church before this mission project? Today's Date Thank you!
