Mission Trip Application

1. Personal Info

AS IT APPEARS ON PASSPORT/NATIONAL IDENTITY CARD

First Name*

Middle Name(s)

Full Last Name(s)*

Birthday (DD/MM/YYYY)*

Street Address*

City / State / Zip*

Cell Phone*

Email Address*

Social Media (Insta, Facebook, ...)

Occupation

Spouse's Name (if married)

Names of Parents or Guardian(s)

Parent's Phone Numbers

Parent's Street Address / City / State / Zip (if different from applicant)

Do you have a passport?

*Please send a photocopy/scan of your passport to betsy@goawakening.org

2. Spiritual Background

Church Name

Church Address

Church Phone

Youth Pastor

Youth Pastor Phone

Pastor*

Pastor Phone

Have you accepted Jesus Christ as your personal savior?

If so, when?

Are you currently involved in any type of ministry in your church/community?

If so, please describe briefly:

Have you ever led someone to the Lord?

Have you ever been on a mission trip?

If so, please state when, where, and the type(s) of ministry in which you participated:

Do you have any special skills you would like us to know about for this team?

If so, please explain:

Please share with us briefly about why you want to serve on this team:

Are you in agreement with the mission statement and articles of faith of the IPHC?

For more info, visit iphc.org/beliefs

3. Medical History

Name*

Birth date*

Do you have any medical conditions and/or injuries that might result in difficulty walking, hiking, riding in a vehicle for long periods of time, carrying your own luggage or be aggravated by prolonged exposure to the elements or lack of adequate restroom facilities in some locations?

If so, please list below:

Do you have any allergies to medications, foods, etc.?

If so, please list ALL below:

Are you currently taking any medications?

If so, please list below:

Are you up to date with all immunizations? (Hepatitis, meningitis, etc.)

Do you have any special dietary needs as prescribed by a doctor?

If dietary needs, please list below:

I understand that it is my responsibility to pursue all immunizations and/or medications, such as Malaria prevention medication, that may be required or recommended by health officials.

4. Primary Physician & Health Insurance

Doctor’s Name

Doctor Phone

International Health Insurance Coverage: Does your health insurance cover you internationally?

5. Emergency Contact

Emergency Contact Name*

Phone*

Relationship*

Street Address

Email

6. Assumption of Risk and General Release Form

📄 Please click the button below to review the official terms and conditions document:

View Assumption of Risk & General Release Form (PDF) ↗

I have carefully read, understand, and freely agree to all the terms of the Assumption of Risk and General Release Form.*