Local/Stateside Trip Application

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This application is confidential and will only be used to determine suitability for the trip.

Email *

GO Trip Selection: *

Personal Information

Full Legal Name: *

Address: *

City/State/Zip: *

Cell Number with area code: *

Home Number with area code:

Date of Birth *

YYYY

Your T-Shirt Size (Adult sizes): *

XXL

Additional t-shirts needed for children going with you. Please list name and youth size:

Emergency Contact Information

Name: *

Relationship: *

Address: *

Primary Phone with area code: *

Alternate Phone with area code:

Medical Information

Your current health is: *

If fair or poor, please explain:

Are you currently taking any medications: *

Yes

If yes, please specify:

Do you have any medical restrictions or handicaps that we need to make special provisions for? *

Yes

If yes, please specify:

Known allergies to medications, pollen, food, etc.:

Blood Type (if known)

Training, Experience and Skills

Summarize your educational and/or vocational training: *

In what ways are you involved with your local church and other ministries? *

Please list any of your skills that may be helpful on this trip:

List previous CBC mission/stateside trips that you have gone on: *

List any non-CBC mission trips that you have gone on and with whom: *

What other cross-cultural experiences have you had? *

Church Affiliation & Testimony

Church Affiliation: *

How long? *

Church phone: *

Pastor's name *

Briefly share how you became a Christian and what God is doing in your life now: *

Why do you want to go on a short-term mission trip? *

What do you feel will be one of your greatest contributions to this trip? *

What concerns you or doesn't sound fun about going on a GO Trip? *

“I will commit to attend the required team training meetings and fundraising events. I will raise the necessary prayer and financial support needed for the trip. I understand that I am responsible for the cost of airfare if I do not go on the trip. I will maintain a spirit of cooperation with the leaders and missionaries during the trip. I will maintain a Christian testimony before those in the host country.” The undersigned also acknowledges that participation in trip described herein also constitutes approval to be photographed and to have those photographs placed in CBC related publications, including the church website.

Required

Electronic Signature: *

Date: *

YYYY

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