Mission Trip Commitment Form

Submit this form to the Missions Office 90 to 60 days prior to departure.

Mission Trip:

Trip Dates:

Exact Name as on Passport:

Passport Expiration Date:

Please provide a copy of your passport to the Missions Office if you are going on an international trip. In most cases, your passport must be valid 6 months after your departure date.

Age During Trip

Date of Birth:



Is there any existing medical situation that has occurred within 3 years of date of this mission trip?

If yes please explain:

Has a doctor recommended that you NOT go on a mission trip?

If yes please explain:

Emergency Contact:

I am committed to go on the above trip and my non-refundable deposit is:

Full Name and Date: (this will be considered your digital signature.)

Scholarship Application Information

How long have you been an active member of Sagemont Church?

Do you attend and iCONNECT class?

Which class?

Do you serve regularly?

What Area?

Are you a consistent financial supporter of Sagemont Church?

Have you received scholarship money for another trip this year?

Share with your friends!