Name of Mission Trip / Ministry A. Personal Information Name: Last, First, Middle Address: Street, City, State, Zip Phone: Email Address: Gender: Male Female Marital Status: Single Married Spouse's Name: B. Passport Information Name: Last, First, Middle Date of Birth Age 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? Yes No Has a doctor recommended that you not go on this mission trip? Yes No 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. Relationship First & Last Name Phone: Address: Street, City, State, Zip Emergency Contact 2 Do not include anyone going with you on this trip. Relationship First & Last Name Phone: Address: Street, City, State, Zip D. Ministry Experience Overview Is this your first mission trip? Yes No How many previous mission trips? Are you a licensed or ordained pastor? Yes No Are you a lay preacher? Yes No Have you ever led a mission trip? Yes No Which One? Would you be willing to give a devotional or speak in a church service? Yes No 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. Agree Disagree The Father, Son, and Holy Spirit are three persons but one God. Agree Disagree 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. Agree Disagree I believe in the priesthood of the believer, that all Christians, followers of Christ, have direct access to God. Agree Disagree I believe in the power of prayer to affect and change lives. Agree Disagree Miracles were supernatural occurrences as presented in the Bible Agree Disagree The eternal security of the believer;once saved always saved. Agree Disagree In a literal Heaven, Hell and spiritual enemy Agree Disagree Man was created by God Agree Disagree Jesus Christ is God's Son, God in the flesh and was born of a virgin Agree Disagree F. Answer Below and Sign I will not use alcohol, tobacco or illegal drugs on this mission trip. Agree Disagree I will adhere to and support the Sagemont Church Core Values on this trip. Agree Disagree 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.