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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.org
to request a PDF version of the questionnaire or by phone at (786) 405-9958.
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* Indicates required question
Email
*
Your email
First Name:
*
Your answer
Last Name:
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State & Zip Code
*
Your answer
Phone Number:
*
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
How did you learn about Scalpel At The Cross?
*
Your answer
Do you have any friends or family members who would like to participate in this mission trip?
Your answer
Would your mission trip be self-funded or sponsored?
*
Your answer
Please list your work history.
Your answer
Do you have knowledge of orthopaedics?
*
Yes
No
Do you have knowledge of surgical equipment?
*
Yes
No
Are you comfortable in a surgical setting?
*
Yes
No
What talents do you feel you could bring to the team? Check all that apply.
*
Artistic/Musical
Compassionate/Encourager
Computer & Tech
Construction/Maintenance
Manual Transmission Driver
Leadership Skills
Organizer/Coordinator
Prayer Support/Witness
Other:
Required
What is your Spanish proficiency?
*
None
0
1
2
3
4
5
6
7
8
9
10
Perfectly fluent in reading, writing, and speaking.
Would you be willing to be an interpreter?
*
Yes
No
Have you been on a mission trip in the past?
*
Yes
No
If you answered YES to the previous question, where did you travel and for how long?
Your answer
Please provide additional details about your mission trip (with which organization and your experience on that trip).
Your answer
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