High School Missions Trip Application

For more info visit onmission.cccm.com/highschool missions trip

1General Info > 2Spiritual Info > 3Review Your Entry
Personal Info
Name Name * First Last
Use full legal name
Which trip are you applying for?
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Sex

Sex Male Female
Age
Date of Birth Date of Birth / MM / DD YYYY
Cell Phone Cell Phone - ### - ### ####
Email
Do you have a passport (for International trips only)
Name as it appears on passport (for international trips only) Name as it appears on passport (for international trips only) First Last
Passport expiration Date( for International trips only) Passport expiration Date( for International trips only) / MM / DD YYYY
Are you a minor?

If you are a minor please provide us with your parent/guardian's information:
Parent's Names
Parent's Phone Parent's Phone - ### - ### ####
Parent's Email 1
Parent's Email 2
Health Info
Do you have any physical concerns that might be a concern on this trip? If so, please describe:
Please list any hospitalizations in the last two years:
Are you currently taking any prescription medication? If so, please describe the medication and purpose:
Practical Info
Have you ever been out of the country before?

Have you ever been out of the country before? Yes No
Where?
Have you ever been on a missions trip before?

Have you ever been on a missions trip before? Yes No
Where?
Do you have any concerns with traveling (air sickness, travel history)?

Do you have any concerns with traveling (air sickness, travel history)? Yes No
If yes, please explain
Do you have any dietary concerns?

Do you have any dietary concerns? Yes No
If yes, please explain
How are you planning to pay for this trip?

How are you planning to pay for this trip? Personal Family Help Fundraising
Other
Please list any talents (drama, singing, musical) or other skills/work experience and your Spanish level
Emergency Info

In case of an emergency, please contact
Full Name
Relationship
Cell Phone Cell Phone - ### - ### ####
Other Phone Other Phone - ### - ### ####
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Enter Your Email Address *

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High School Missions Trip Application

High School Missions Trip Application

Personal Info

Are you a minor?

Health Info

Practical Info

Emergency Info