GO Trip Application
This application is confidential and will only be used to determine suitability for the trip and for ticket and travel insurance information.
Email address *
GO Trip Selection: *
Personal Information
Full Legal Name or Name as on passport for airline ticket information: *
Your answer
Address: *
Your answer
City/State/Zip: *
Your answer
Cell Number with area code: *
Your answer
Home Number with area code:
Your answer
Passport #:
Your answer
Date of Birth *
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Your T-Shirt Size (Adult sizes): *
Additional t-shirts needed for children going with you. Please list name and youth size:
Your answer
Emergency Contact Information
Name: *
Your answer
Relationship: *
Your answer
Address: *
Your answer
Primary Phone with area code: *
Your answer
Alternate Phone with area code:
Your answer
Medical Information
Your current health is: *
If fair or poor, please explain:
Your answer
Are you currently taking any medications: *
If yes, please specify:
Your answer
Do you have any medical restrictions or handicaps that we need to make special provisions for? *
If yes, please specify:
Your answer
Known allergies to medications, pollen, food, etc.:
Your answer
Blood Type (if known)
Your answer
Training, Experience and Skills
Summarize your educational and/or vocational training: *
Your answer
In what ways are you involved with your local church and other ministries? *
Your answer
Please list any of your skills that may be helpful on this trip:
Your answer
List previous CBC mission/stateside trips that you have gone on: *
Your answer
List any non-CBC mission trips that you have gone on and with whom: *
Your answer
What other cross-cultural experiences have you had? *
Your answer
Church Affiliation & Testimony
Church Affiliation: *
Your answer
How long? *
Your answer
Church phone: *
Your answer
Pastor's name *
Your answer
Briefly share how you became a Christian and what God is doing in your life now: *
Your answer
Why do you want to go on a short-term mission trip? *
Your answer
What do you feel will be one of your greatest contributions to this trip? *
Your answer
What concerns you or doesn't sound fun about going on a GO Trip? *
Your answer
*
Required
Electronic Signature: *
Your answer
Date: *
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