Mission Trip Application Form

Name of Mission Trip / Ministry


A. Personal Information

Name: Last, First, Middle


Address: Street, City, State, Zip




Email Address:




Marital Status:


Spouse's Name:



B. Passport Information

Name: Last, First, Middle


Date of Birth




Passport Country Originated


Passport Exp. Date



C. Medical & Emergency Info.

List any medications you are taking.


Do you have any health limitations that might keep you from going on a trip?



Has a doctor recommended that you not go on this mission trip?



Describe if any of the above questions are answered yes.


Describe any chronic diseases or allergies you have.


List any sleeping conditions you have(snoring, insomnia, etc.).


Emergency Contact 1

Do not include anyone going with you on this trip.




First & Last Name




Address: Street, City, State, Zip


Emergency Contact 2

Do not include anyone going with you on this trip.




First & Last Name




Address: Street, City, State, Zip



D. Ministry Experience Overview


Is this your first mission trip?


How many previous mission trips?


Are you a licensed or ordained pastor?


Are you a lay preacher?


Have you ever led a mission trip?


Which One?


Would you be willing to give a devotional or speak in a church service?


Do you speak any foreign languages? If so please list them and indicate your fluency as "Good" or "Fair".


List any special talent(s):


E. What I Believe Concerning God

The following statements affirm the doctrinal position of Sagemont Church and its mission program. Please indicate weather you agree or disagree.


The Bible is God's Word. It is inspired, inerrant and infallible.


The Father, Son, and Holy Spirit are three persons but one God.


I believe when a person repents of their sins and turn by faith to Christ, they are saved by God's grace and that Christ is the only thing that saves them.


I believe in the priesthood of the believer, that all Christians, followers of Christ, have direct access to God.


I believe in the power of prayer to affect and change lives.


Miracles were supernatural occurrences as presented in the Bible


The eternal security of the believer;once saved always saved.


In a literal Heaven, Hell and spiritual enemy


Man was created by God


Jesus Christ is God's Son, God in the flesh and was born of a virgin


F. Answer Below and Sign


I will not use alcohol, tobacco or illegal drugs on this mission trip.


I will adhere to and support the Sagemont Church Core Values on this trip.


Enter full name and date, this will be considered your digital signature.


G. Submit Your Personal Testimony

Word or PDF documents are acceptable.


Please include the following in your testimony.

  • A few words of who you are; i.e. your name, something that tells others who you are.
  • A paragraph stating my life before I became a Christian
  • A paragraph stating how I became a Christian; i.e. the circumstances surrounding my salvation.
  • A paragraph stating what Christ means to me and what He has done in my life after becoming saved
  • A few words of a closing stating what a non-believer should do
  • Your goal should be to not generate more than a type written page and include the key points in your testimony that would encourage others to make the same decision that you have made.

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