MISSION TRIP REGISTRATION FORM

First Name

Last Name

Male

Female

Date of Birth

Age

Shirt Size

Cell Phone

Home Phone

Address

City

State

Zip

Place of Employment

Occupation

Please tell us on a scale of 1 to 10 how you see yourself:

Introverted

Extroverted

I work well with people

i work well with projects

I work better alone

I work well with others

I follow directions

I give directions

What campus do you usually attend?

Have you served in a ministry at DSC?

If so, what ministry and for how long?

Are you a US citizen?

Do you have a valid passport?

Have you been on a mission trip before?

If so to where and when?

Please list any abilities or talents that you have that may be useful in ministry?

PERSONAL TESTIMONY

1. What were your struggles before you committed your life to Christ?

2. When did you come to know Jesus Christ as your Lord and Savior?

3. How has your life changed since you first believed in Christ?

4. What is God doing in your life today? What is he the teaching you recently?

MEDICAL INFORMATION

My full name:

My emergency contact’s name

Their relation to me (mother, father, etc.)

Their cell phone number

Other

My medical/drug allergies

My food allergies

My activity limitations

Medications I am taking (name and dosage)

My doctor’s name

My doctor’s phone number

MY MEDICAL INSURANCE INFORMATION

Insurance provider

Insurance policy number

ID or Group Number:

Phone Number

OVER 18 CLAUSE

I am 18 years of age or older, and have provided information about any medical conditions I have. In addition, I have provided my medical insurance information.

Signature of person over 18 years of age:
(by signing, you confirm that the information provided is accurate to the
best of your knowledge)

Your Signature

Print name

Date

Thanks for registering to a mission trip!