Name of Mission Trip / Ministry A. Personal Information Name: Last, First, Middle Address: Street, City, State, Zip Phone: Email Address: Gender: MaleFemale Marital Status: SingleMarried 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? YesNo Has a doctor recommended that you not go on this mission trip? YesNo 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? YesNo How many previous mission trips? Are you a licensed or ordained pastor? YesNo Are you a lay preacher? YesNo Have you ever led a mission trip? YesNo Which One? Would you be willing to give a devotional or speak in a church service? YesNo 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. AgreeDisagree The Father, Son, and Holy Spirit are three persons but one God. AgreeDisagree 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. AgreeDisagree I believe in the priesthood of the believer, that all Christians, followers of Christ, have direct access to God. AgreeDisagree I believe in the power of prayer to affect and change lives. AgreeDisagree Miracles were supernatural occurrences as presented in the Bible AgreeDisagree The eternal security of the believer;once saved always saved. AgreeDisagree In a literal Heaven, Hell and spiritual enemy AgreeDisagree Man was created by God AgreeDisagree Jesus Christ is God's Son, God in the flesh and was born of a virgin AgreeDisagree F. Answer Below and Sign I will not use alcohol, tobacco or illegal drugs on this mission trip. AgreeDisagree I will adhere to and support the Sagemont Church Core Values on this trip. AgreeDisagree 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.