Mission Trip Questionnaire
If you prefer to print and fill out a hard copy of the form or have any questions, please contact us by email at info@scalpelatthecross.orgĀ to request a PDF version of the questionnaire or by phone at (786) 405-9958.

Sign in to Google to save your progress. Learn more
Email *
First Name: *
Last Name: *
Street Address *
City *
State & Zip Code *
Phone Number: *
Date of Birth: *
How did you learn about Scalpel At The Cross? *
Do you have any friends or family members who would like to participate in this mission trip?
Would your mission trip be self-funded or sponsored? *
Please list your work history.
Do you have knowledge of orthopaedics? *
Do you have knowledge of surgical equipment? *
Are you comfortable in a surgical setting? *
What talents do you feel you could bring to the team? Check all that apply. *
What is your Spanish proficiency? *
Perfectly fluent in reading, writing, and speaking.
Would you be willing to be an interpreter? *
Have you been on a mission trip in the past? *
If you answered YES to the previous question, where did you travel and for how long?
Please provide additional details about your mission trip (with which organization and your experience on that trip).
Clear form
Never submit passwords through Google Forms.
This form was created inside of Scalpel At The Cross. Report Abuse