Life Church Peoria Mission Application
Please fill out this form and click submit.
Mexico Mission Trip
Thank you for your interest in participating in missions trip with Life Church.
Name
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Gender
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Email
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This address will receive a confirmation email
Phone
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Address
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AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
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DC
DE
FL
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GA
GU
HI
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ID
IL
IN
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LA
MA
MB
MD
ME
MH
MI
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MO
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TN
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UT
VA
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VT
WA
WI
WV
WY
YT
Occupation
What langugaes do you speak and at what level?
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TRAVEL INFO
Passport Number
Name exactly as it appears on your passport
Passport Issuing Country:
Passport Issued On:
Passport Expire On:
KTN/TSA Pre-Check Number
Seat Preference:
TRIP FUNDING
Please Choose One
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Please select all that apply.
I will personally fund the trip.
I need to fundraise the entire cost of the trip.
I will fundraise, and personally cover the remaining amount.
EMERGENCY CONTACT
Emergency Contact:
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Emergency Contact Relationship:
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Emergency Contact Phone Number:
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HEALTH INFO
Do you have any known allergies (food, drugs, other)? If yes, please list. If no, type "no"
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If you are currently taking mediations, briefly list any medications, including dosages:
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Do you have any limitations or health conditions that many affect your involvement? If yes, briefly describe
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Are you currently receving medical treatment or under medical observation for anything? If yes, biefly describe
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Are you able to walk 2 miles on uneven surfaces?
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Please select all that apply.
Yes
No
With assistance
Health Insurance Company
Insurance Policy or Group Number
LIFE CHURCH CONNECTION
Briefly share your experience with Life Church: when did you start attending? How are you involved? (Sunday services? A group? Volunteering?
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Have you put your personal faith in Jesus?
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Please select all that apply.
Yes
No
What would you say if someone asked How do I become a Christian?
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MINORS
Is the applicant at least 18 years of age or older?
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Please select all that apply.
Yes
No
If you are completing this application on behalf of an applicant, who is under the age of 18, you are representing that you have legal decision making authority under Arizona law for the applicant
Please select all that apply.
Yes
No
Your Full name as the legal guardian
If you are the applicants parent/guardian, has a court entered an order governing legal decision making for the applicant?
Please select all that apply.
Yes
No
If a court has entered an order governing legal decision making for the applicant, please specify whether you have been granted joint or sole legal decision making for the applicant.
Please select all that apply.
Joint
Sole
COVENANT
My personal life reflects Biblical values.
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Please select all that apply.
Agree
Disagree
I understand team meetings are critical and I will make attending them a priority.
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Please select all that apply.
Agree
Disagree
I will respect the work that is going on in country with the churches and organizations.
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Please select all that apply.
Agree
Disagree
I will follow safety precautions at all times.:
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Please select all that apply.
Agree
Disagree
I will not use alcohol, drugs, or tobacco during my team experience.
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Please select all that apply.
Agree
Disagree
I will avoid using vulgar language, curse words, and engaging in inappropriate conversations.
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Please select all that apply.
Agree
Disagree
I will dress appropriately.
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Please select all that apply.
Agree
Disagree
All monies donated by others toward mission trips are tax deductible and non-refundable.
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Please select all that apply.
Agree
Disagree
Any excess fundraising monies donated by myself or others are non-refundable and will be used to benefit the mission project and team.
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Please select all that apply.
Agree
Disagree
I am responsible for any outstanding balance on the due date or my trip may be forfeited.
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Please select all that apply.
Agree
Disagree
By signing I indicate that I fully understand and agree with all of the above statements.
*
Please select all that apply.
Agree
Disagree
Thank you for your insterest in missions at Life Church! The Missions team will reach out with next steps in the next 7-10 buiness days.
Submit
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