Registration - Dominica 2018!!
Email address *
Full Name
(Exactly what the government calls you on your passport. Also probably what your mom called you when she was really mad)
Your answer
Birthdate
MM
/
DD
/
YYYY
Address
Your answer
Cell Phone #
Your answer
Gender
Intended Primary Group
Do you have a valid, non-expired US passport?
If not, you need to get on that *now*. As in, this exact instant. Put down Fortnite and do it
Passport Number
Or say "working on it"
Your answer
Where do you consider to be your home church?
Your answer
How long have you been attending?
Your answer
How often do you attend?
Your answer
What ministry/ministries are you a part of, if any?
Your answer
How long have you been involved in them?
Your answer
Name of that ministry's overseer
Your answer
Phone number of ministry overseer
Your answer
What do you see as your primary spiritual gifts?
Your answer
What do you see as your primary non-spiritual gifts?
e.g. drawing, soccer, nunchucks. If you say "being a Twitter troll" you're not coming
Your answer
Are you musical? If so, what instruments do you play?
No, mouth trumpet doesn't count
Your answer
Health Information
Emergency Contact (EC) Name:
Your answer
EC Address
Your answer
EC Phone Number
Your answer
Are you currently taking any medication?
Your answer
Do you have any medical restrictions, handicaps, and/or bounty on your head that we need to make provisions for or should be aware of? If so, please explain.
Your answer
Health Insurance Company
Your answer
Policy Number
Your answer
Physician's Name
Your answer
References
Reference #1 Name
Your answer
Reference #1 Relationship
Your answer
Reference #1 Phone Number
Your answer
Reference #1 Email
Your answer
Reference #2 (Pastoral) Name
Your answer
Reference #2 (Pastoral) Relationship
Your answer
Reference #2 (Pastoral) Phone Number
Your answer
Reference #2 (Pastoral) Email
Your answer
You
A simple paragraph or two will suffice; no need for essays!
Please list any mission trips you have been on previously, if any:
Your answer
Share your God-story: how did you come to a personal relationship with Christ?
Your answer
Why do you want to go on this trip?
Your answer
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