PHCH Missions Trip Application

PERSONAL INFORMATION

Name

This address will receive a confirmation email

Phone

Address

CHURCH INVOLVEMENT

Name of the local church you actively worship and serve with:

Is your church affiliated with the West Texas Assemblies of God?

Yes No

Are you an official member of your church?

Do you support your church through the giving of tithes and offerings?

Yes No

Do you regularly provide financial support to the mission ministries of your church?

Yes No

What ministry and community outreach activities are you currently involved in?

Have you participated in any U.S. mission trips, whether church-related or district-related, in the past two years?

Yes No

Have you had any training or experience in sharing your faith?

Yes No

HEALTH

Please list any pre-existing illnesses, surgeries, allergies, or medical conditions.

Please list any medications you are presently taking.

Please list any special dietary needs.

Do you consider yourself in good health? If not, please explain

Name and phone number of your doctor:

Do you have any health conditions or physical limitations that could hinder your full participation in activities like walking in high/humid temperatures, performing light renovations, carrying/moving boxes, etc.? If so, please explain.

PERSONAL FAITH

Please write a brief testimony sharing your salvation experience, including when and where it occurred:

Why are you interested in taking this mission trip?

What two things do you hope to see the Lord do in and through you on this mission trip?

Please list any skills, talents, or gifts that you feel may be helpful to this team.

How do you hope to be different as a result of participating on this team? What do you want God to do in you?

PASTORAL REFERENCE

Pastor's Name

Pastor's Role

Pastor's Email

Pastor's Phone

PERSONAL REFERENCE (Friend/Co-Worker/Spiritual Mentor (non-relative))

Reference's Name

Relationship to Applicant

Reference's Email

Reference's Phone

AUTHORIZATION

The information I have provided is accurate and true to the best of my knowledge. If deemed necessary, I consent to the West Texas Assemblies of God conducting a criminal background check. I also authorize West Texas Assemblies of God to use my image, voice, and/or testimony in any form of promotional advertising materials that may be created.

My typed signature below (and the signature of my parent or legal guardian if I am under the age of 18) signifies my authorization.

If selected to join this short-term mission team, I commit to:
1. Fulfill all requirements
2. Complete all training processes before departure and after I return from the trip.
3. Act in a manner that honors the Lord as I work alongside my team to serve Him.
4. Submit to the authority of the pastor, team leader, and the host on the field, as well as to team policies presented by those authorities.
5. Refrain from any behavior that may compromise my Christian witness and that of the team.

If my behavior is a problem at any point during the project, the team leader is authorized to send me home. Any additional costs incurred as a result of this action will be at my expense.

I have read and fully agree to all the conditions listed above.

Yes No

Signature of Applicant

LEGAL WAIVER

I understand that all positions on this mission team are voluntary and do not provide financial compensation.

I agree to uphold the Mission, Vision, and Core Beliefs of West Texas Assemblies of God.

I acknowledge that covering expenses, including travel to and from the designated mission location, will be my responsibility.

I recognize that West Texas Assemblies of God has the authority to terminate my participation in this ministry at any time at its sole discretion.

I acknowledge that participating in a trip of this nature may involve hazards or dangers. Therefore, I, for myself, my heirs, executor, and/or administrator, release and forever discharge West Texas Assemblies of God and all its officers, agents, servants, and employees- acting officially or otherwise- from any and all claims of injury, damage (including property damage to any of my belongings), loss, or death that may occur from any cause, including, but not limited to, any accident and/or incident while participating individually or with others in this mission agency and/or on this mission trip.

Furthermore, I understand that all contributions or payments made to West Texas Assemblies of God for the purpose of this Mission Trip are non-refundable if I decide not to participate in the program. The financial distribution of these funds is at the discretion of West Texas Assemblies of God and shall not be refunded.

I have read and fully agree to all the conditions listed above.

Yes No

Signature of Applicant

PHCH Missions Trip Application

Description

Please Fix the Following