Short Term Missions Trip Application
Application Date
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Trip Destination
Your answer
Personal Information
First Name
Your answer
Last Name
Your answer
Date of Birth
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Gender
Nationality
Your answer
Country of Birth
Your answer
Address
Your answer
Email Address
Your answer
Phone Number
Your answer
Current Occupation
Your answer
Marital Status
Spouse's Name (If Applicable)
Your answer
What is the best way to reach you?
Passport Information
Name (as it appears on your passport)
Your answer
Passport #
Your answer
Date of Expiration
MM
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DD
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YYYY
Date & Place of Issue
Your answer
HKID #
Your answer
Church Involvement
How long have you attended ECC?
Your answer
Are you a member of ECC?
If yes, when did you join?
MM
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DD
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If not, are you a regular attendee?
Do you regularly attend an ECC small group?
If yes, which one?
Your answer
In what other ministries do you currently serve/participate in at ECC?
Your answer
Missions Experience
Have you been on any other mission trips?
If no, please provide a reference that the Mission & Outreach staff can contact on your behalf
Your answer
Name of Reference
Your answer
Email of Reference
Your answer
If yes, please provide the date and location of previous mission trips.
Your answer
1) Location & Year:
Your answer
Organized by:
Your answer
2) Location & Year:
Your answer
Organized by:
Your answer
Gifts/Skills
Are you aware of your spiritual gifts?
If so, please list them:
Your answer
Languages
Talents/Gifts/Skills (We can use them all to serve the nations!):
Your answer
Personal Testimony
Have you led someone to accept Christ as savior?
Have you ever shared your testimony before a group?
Please tell us your salvation story, including when you were baptized.
Your answer
Specifically, why do you want to go on this trip?
Your answer
Insurance/Medical Information
Do you have your own travel insurance?
Company:
Your answer
Policy Number:
Your answer
Please list any serious health conditions:
Your answer
Please list ALL medications taken on a regular basis:
Your answer
Please list any allergies:
Your answer
Please list any other health issues or illnesses that could affect your participation:
Your answer
Physician's Name:
Your answer
Physician's Phone Number:
Your answer
Designated Beneficiary:
Your answer
Relationship:
Emergency Contact
Name
Your answer
Relationship
Address
Your answer
Phone #
Your answer
By submitting this form, I agree to the following:If accepted for this trip, I will participate voluntarily and of my own free will. I will not hold Evangelical Community Church (ECC), its agents, employees, and volunteer assistants, or the sponsoring mission organizations/missionaries responsible for any accident, injury, illness, death or other personal loss that might result from this trip and I will release them from any liability, whether arising from the negligence of those persons or otherwise.I authorize trip leaders as my agents, to consent to any emergency treatments, anesthetics and operations on me, as in the opinion of the attending physician that is necessary in the case of accident or illness.I am expressing my agreement with ECC’s Vision, Mission, Goal, Values, Strategy, and Statement of Beliefs. I will submit to trip leadership and maintain a cooperative spirit. I am willing to conform to the standards of the national Christians, even if those standards are stricter than my own. To the best of my ability, I will participate in trip preparation and debriefing sessions.
Name of Applicant
Your answer
Date
MM
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DD
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YYYY
This form contains personal information and will be kept confidential at the ECC office.
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