MISSION TRIP APPLICATION FORM

APPLICATION AGREEMENT *

"I AGREE TO SERVE UNDER THE LEADERSHIP OF WORLD HARVEST CHURCH MISSIONS MINISTRIES. I UNDERSTAND THAT MY APPLICATION, IF FOR INTERNATIONAL TRIP, IS TO BE ACCOMPANIED BY A COPY OF MY PASSPORT, WHICH CAN BE UPLOADED OR EMAILED TO [email protected], AS WELL AS A NON-REFUNDABLE $100.00 ADMINISTRATIVE FEE, (NOT REQUIRED TO COMPLETE THIS APPLICATION). I ALSO UNDERSTAND THAT IF I DON’T HAVE A PASSPORT AT THE TIME I SUBMIT MY APPLICATION, IT IS MY RESPONSIBILITY TO APPLY FOR ONE IMMEDIATELY. I UNDERSTAND THAT I WILL NOT BE GRANTED ACTIVE STATUS FOR THE TRIP UNTIL APPLICATION, ADMINISTRATIVE FEE AND COPY OF PASSPORT ARE ON FILE AT WORLD HARVEST CHURCH. I UNDERSTAND THAT SHOULD I CANCEL MY RESERVATION FOR ANY REASON, WORLD HARVEST CHURCH IS NOT LIABLE TO REFUND ANY MONIES ONCE AIRLINE TICKETS HAVE BEEN PURCHASED. ADDITIONALLY, ANY EXPENSE THAT HAVE OCCURRED OR WILL OCCUR THAT CANNOT BE REFUNDED OR AVOIDED MUST BE PAID BY PARTICIPANT.

* You may be required to submit to a background check if you will be serving with children.

TRIP INFORMATION

All trips not listed as confirmed are still tentative due to COVID-19 travel restrictions. All international trips require a 24-72 hour negative COVID-19 test and some require a COVID-19 Vaccine as well.

Select Global to see trip list. (Important: all trip destinations, dates, costs and leaders are subject to change.) *

Global

TL = Trip Leader / AF = Airfare

Select 2022 mission trip(s) you are interested in: *

International Mission Trip
Johnson City, TN Shuttlesworth| May 29-June 3 |$tbd
Zambia (TTN | May 22- June 2|$970 + AF, PCR tests, some meals, Visa
York, PA Shuttlesworth|June19-26|$tbd
Bangor, ME or Baltimore, MD Shuttlesworth |July 24-28|$tbd
Scranton, PA Shuttlesworth |Aug 28-Sep 4|$tbd
South Africa | Oct | $TBD |Jeremy Miller /Stoney
Undecided/Future Trip/My trip's not listed here yet

PERSONAL INFORMATION

Please complete all fields to the best of your knowledge before submitting your application.

Legal First & Last Name *

First

Middle

Last

Preferred Name

First

Last

Email: *

Cell Phone # *

Other Phone #

Address

Address Line 1

Address Line 2

City

State

Zip Code

T-Shirt Size ($10 per shirt or included in the $100 admin fee) *

Clarkston Mission Trips not qualified for t-shirts; cost is $10.00 per shirt.

Date of Birth *

Enter: mm/dd/yyyy

If you are under the age of 18 please check below.

Under 18

What will your age be at the time of your trip? *

Do you have one or any of the following (check all that apply): *

CDL (Commercial Driver's License)
Driver's License
Learner's Permit
N/A

Are you willing to drive the StreetReach truck or Shuttle? (24 passenger shuttle requires CDL) *

StreetReach Truck
24 Passenger Shuttle (I have a CDL)
14 Passenger Shuttle (No CDL required)
N/A

Do you have a valid passport? (Six Month Validity Passport Rule. As a general rule, passports should have at least six months of validity when traveling internationally. Most countries will not permit a traveler to enter their country unless the passport is set to expire at least six months after the final day of travel.) *

Yes
No
Application in progress

Passport Number *

Passport Name: (Exactly as name appears on passport) *

First

Middle

Last

Passport Expiration Date *

IMPORTANT: Six Month Validity Passport Rule. As a general rule, passports should have at least six months of validity when traveling internationally. Most countries will not permit a traveler to enter their country unless the passport is set to expire at least six months after the final day of travel.

Upload picture of your passport information

Click or drag a file to this area to upload.

Marital Status *

Single
Married
Divorced
Widower

Gender: *

Male
Female

Emergency Contact First and Last Name *

Emergency Phone # *

Emergency contact relationship *

Are you a member of WHC? *

Yes
No
Membership in progress

Is this your first mission trip? *

Yes
No

List the countries or cities you have been to for missions:

What talents, skills, or previous experiences can you bring to this mission trip? *

What are your spiritual gifts? (Word of Wisdom, Word of Knowledge, Faith, Gifts of Healings, Miracles, Prophecy Distinguishing between Spirits, Tongues, Interpretation of Tongues) *

Do you serve at WHC? *

Yes
No

The position/department you serve at WHC

Health Information

NAME OF HEALTH INSURANCE PROVIDER

Health Ins Policy #

Doctor's Name

Doctor's Phone #

Do you have any allergies to food, medication, etc.? *

Yes
No

List of any allergies: Medication, foods, other. *

Do you have any medically mandated diet restrictions? *

Yes
No

List all medically mandated diet restrictions:

Do you have the following? *

Do you have any chronic or ongoing health conditions other than those mentioned above? *

Yes
No

List any chronic or ongoing health conditions:

Are you currently taking any prescription medication? *

Yes
No

List any prescription medication you are currently taking:

How would you describe your overall health?

Vaccinations: *Based on the location of your mission trip some vaccinations are REQUIRED. Please refer to the Get Ready - Trip Preparation tab for more info or check with your trip leader. *

I have contacted my personal physician or the Department of Public Health (404-657-2700) and have received the REQUIRED shots needed to go on this mission trip.
None yet other than vaccines recommended for the United States.

List any shots received:

Additional Comments:

AGREEMENT INFORMATION

AGREE: TYPE IN YOUR NAME *

First

Last

Signature

Sign your name using a mouse

Mission Trip Personal Waiver /Release Statement *

I understand that this is a mission trip focused on sharing the Gospel of Jesus Christ. I release World Harvest Church and the World Harvest Church Missions Ministry from personal responsibility for accidents, sickness, or injury during the course of, or as a result of the trip. I also release World Harvest Church and the World Harvest Church Missions Ministry from responsibility for any lost or stolen possessions that might occur during the trip. As determined by World Harvest Church, I agree to submit to a background check in the event that I will be working with children. I will abide by the authority and decisions made by the World Harvest Church and the World Harvest Church Missions Ministry.

Seed For the Nations Deposit Information *

Review your application before you hit Submit. After you submit your application form you will be directed to the payment site where you can make a deposit, however YOU ARE NOT REQUIRED TO MAKE A DEPOSIT at this time. To deposit money into your personal SFN account for your trip, select "Seed" from the menu options. Select Deposit to Self.