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TKC MISSION APPLICATION 1

THANKSGIVING CHURCH MISSION APPLICATION FORM

Desired Mission Trip:

Personal Data (Please type or print clearly)

Last Name: ______________________________ First Name: _________________________________

Name as it appears on passport for placing on airline ticket (if different): __________________________

Passport #: __________________ Gender: M/F

Date of Birth: ___/___/___

Street Address: ____________________________________________________ Apt #: _____________

City: ___________________________________ State: _____ Zip: _____________

Home Phone: _________________________ Cell: _________________________

E-Mail: ___________________________________________________________

Name(s) of parent(s) or guardian(s):

____________________________________ ____________________________________

List 2 References (church staff, SG leader, co-worker in church):

Reference #1: ________________________________ Relationship: __________________________

Phone/Email: __________________________________________________________________________

Reference #2: ________________________________ Relationship: __________________________

Phone/Email: __________________________________________________________________________
Medical Information
Please be honest and complete with your medical history since this information is important to the
environment in which you may be working.

List all medical problems for which you have received medical care in the past 12 months:

List any prescription drugs (and their generic names), which you are now taking:

List any history of major illness or surgery:

List any known allergies (including food allergies) or chronic life-threatening conditions:

List any known physical limitations and/or disabilities:

Describe your present physical fitness (e.g., walking, manual labor, heavy lifting, carrying luggage)
(Circle one)

Poor/Average/Good/Excellent
TKC MISSION APPLICATION 3

Emergency Information (Please complete and sign)

In case of emergency, contact:

Name: _______________________________________________________________________________

Address: ______________________________________________________________________________

City: ______________________ State: ______Zip:________________

Relationship to Applicant: ____________________________________

Home Phone: ______________ Work Phone: _____________


Insurance Information
Please contact your insurance company and verify that your coverage is valid for travel within the
country to which you are going. If you are not covered, it is the responsibility of you and your team
leader to make sure that you purchase short-term coverage for the time that you are out of the U.S.

Are you covered by health insurance? (Circle One) Yes No

If yes, does your insurance cover you internationally? (Circle One) Yes No

Name of Insurance Company: _________________________

Policy #: _________________________

Please answer if you are under 22 years old:


Have you discussed your desire to participate in summer missions with your parent/guardian?

(Circle One) Yes No

If Yes were they (Circle One):

In favor? Opposed? Neutral?

I declare by my signature below that:


1. I affirm that all of the information on the application and the attached sheets is true and complete
to the best of my knowledge.
2. I hereby release Thanksgiving Church, its staff, and volunteer assistants from any liability arising out
of any injury, damage, or loss which may be sustained by said person during the course of
involvement with Thanksgiving Church.
IN THE EVENT OF AN EMERGENCY WHERE MEDICAL TREATMENT IS REQUIRED, I GIVE MY
PERMISSION TO THE THANKSGIVING CHURCH STAFF OR SPONSER TO OBTAIN THE SERVICE OF A
LISCENSED PHYSICIAN. I AM AWARE THAT THANKSGIVING CHURCH WILL NOT BE RESPONSIBLE FOR
ANY INJURIES, DEATH, OR ACCIDENTS THAT THE APPLICANT MIGHT BE INVOLVED IN. I WILL TAKE
FULL RESPONSIBILITY FOR ACTIONS. TKC STAFF RESERVES THE RIGHT TO SEND APPLICANTS HOME
FOR INAPPROPRIATE BEHAVIORS.

Signature of Applicant Signature of Parents (if under 18)

_______________________________________ _______________________________________

Date

_________________________ ___________________________
TKC MISSION APPLICATION 5

Please answer these questions as thoroughly as you can.

I. Personality Profile
1. Describe your personality
2. Describe your personal strengths, special skills and knowledge which may be useful during the
mission trip.
3. Describe your weaknesses.

II. Mission Experience


Outline the mission trips you have taken.
Trip Name:
Dates/Year:
Describe the experience briefly:
III. Personal Spiritual Information
1. When did you become a Christian? (Give a brief description of your spiritual journey as a
Christian.)
2. Describe your current relationship with Jesus Christ and how you are serving in Christian ministries
currently.
3. What is your purpose of joining the mission team?
4. What expectations do you have for this trip and what contribution can you bring to the mission
work this time?
5. How do you plan to raise fund for the mission trip?

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