First Hot Springs - Mission Trip Application

Personal Information

First Name (as it appears on your passport)

Last Name

Middle Name

Preferred Name (if different from legal name)

Date of Birth

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Email

Phone Number

Alternate Phone Number

Sex

Male

Female

Will you be carrying a phone with you on the trip?

Yes

No

Are you a member of this church?

Yes

No

In Process

Which trip are you applying for?

Passport Number

Expiration Date

Travel Insurance beneficiary and relationship to you

Medical Information

Please list any critical medications presently taking and reason for medication

Please list any known allergies to medications, foods, or insects

Plan to bring extra amounts of any critical medications you take in the event the trip does not return on the scheduled times. Pack all medications in your carry on.

Emergency Contact

Emergency Contact Name

Relationship to you

Emergency Contact Email

Emergency Contact Phone Number

Payment Information

Please sumbit a $100 deposit within 1 week of applying for your trip. All payments should be given to the church office with trip name on the memo line. Per IRS regulations, money donated to any trip is technically for the trip, not a person, and may not be refunded but can be held for additional trips. We will keep an internal accounting of whose account it goes in. Any overages will be returned to the general missions fund or the next trip to a partner location. The final payment for the trip must be made before you leave on the trip unless other arrangements have been made.

Additional Paperwork

Have you completed a background check?

Yes

No

Mission Trip Participant Application