Name*

Email*



Address

Family/Personal Physician*



Physician Phone*



Emergency Contact*



Emergency Contact Number*



Do you have any chronic or current health problems that might be affected by the environment and living conditions in a third world country?*

YesNo

If so, what is the health condition?



In which of these areas do you feel like God has gifted you? (Please check all that apply.)*

Personal EvangelismPreachingTeachingChildren's MinistryMedical MinistryConstruction

The church to which you belong*



Church Address

Church ministries in which you are/have been involved



Have you ever been on a mission trip?

YesNo

Testimony*

Please share the circumstances surrounding how the Lord saved you. Also, please share your reasons for wanting to participate in this mission work.

Responsibility*

Chosen People International is acting only in the capacity of agent and facilitator in matters of transportation and mission operations. CPI assumes no responsibility for injury, damaged or lost of property, or other losses/expenses caused by delays, sickness, quarantine, airlines, other transportation companies, or from other individuals, companies, or circumstances not controlled by CPI. CPI reserves the right to make alterations in the itinerary. CPI also reserves the right to accept, decline, or retain any person as a member of the mission trip at any time.

I accept

Conduct*

You affirm to submit to the Chosen People trip leader in all matters, abstain from pursuing romantic relationships with team members or nationals, abstain from using alcohol or tobacco for the duration of the trip, and to act as a servant-disciple of the local ministry.

I accept

Risk*

I understand that any mission trip includes an inherent level of explicit and implicit risk. Travel accidents, sickness, and injuries are among these risks. Further, I have reviewed the information about the mission trip country found on the Consular Sheets produced by the U.S. State Department at the following Web site (CLICK HERE). I knowingly accept the risks of participating in this mission trip.

I accept

Statement of Beliefs*

I have read and agree to serve in accordance with and not contrary to the statement of faith adopted from The Gospel Coalition while serving with Chosen People International.

I accept