Young Adult Winter Mission Trip 2019 - North Carolina
Please complete this form in its entirety. Take care to ensure all information is correct. We will be traveling to North Carolina to aid in hurricane relief from December 26th to December 31st, 2019. If you have any questions please don't hesitate to reach out to Matt Grobinski via email at
. Thank you for joining us!
What is your first name?
What is your last name?
What is your email address?
What is your cell phone number (including area code)?
How old will you be as of December 26th, 2019?
Do you have experience driving 12-15 passenger vans?
If yes, would you be willing to drive?
Do you have any specific skills (construction or ministerial) that may help lead the group? If so, please explain.
Who should we contact in the event of an emergency? Please include full name and phone number.
Medical Insurance Information: Please include provider name, Group Number, and ID Number (in that order)
Do you have any food allergies? If so, please list below.
Do you have any dietary restrictions/needs? If so, please list below
Do you have any drug allergies? If so, please list below.
What is your t-shirt size?
Is there anything else you think I should know about you to make this trip a success?
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