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• Full Legal Name:______________________________________________________________________

 

• Address:__________________________________________________________

 

                      __________________________________________________________

 

• Social Security Number:

 

• Date of Birth: ______________________  Phone:_________________________

 

• Parent (s)  Name: ___________________________________________________

 

• Parent (s)  Phone  No.’s : ___________________________________________

 

• Parent Signature__________________________________________________

 

• Do you have a passport?        Yes____  #____________________                No____

 

• E-Mail Address _____________________________________             T-Shirt Size:__________

 

• Why are you considering this Guatemala Mission Trip? 

 

          __________________________________________________________________________________________

 

                  __________________________________________________________________________________________

 

• What church do you attend, for how long, are you involved in any ministries?  ____________________

 

          __________________________________________________________________________________________

 

                  __________________________________________________________________________________________

• Please list all service opportunities you have participated in this past year:

 

                  __________________________________________________________________________________________

 

                  __________________________________________________________________________________________

 

                  __________________________________________________________________________________________

 

• Currently, what is God teaching you about Himself?  ____________________________________________

 

                  __________________________________________________________________________________________

 

                  __________________________________________________________________________________________

 

                  __________________________________________________________________________________________

 

• How do/does your parent(s) feel about you attending this trip? ___________________________________

 

                  __________________________________________________________________________________________

 

• Special prayer requests:  ______________________________________________________________________
• Please list all medication you are currently taking:_______________________________________________
• Please list any allergies or physical limitations (be specific):_____________________________________

 

                  __________________________________________________________________________________________

 

                          __________________________________________________________________________________________

 

(Applications can be turned in at FCC, 4240 Wisconsin St, marked Attn:  Scott Luber)

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