Village Church Burbank

GENERAL INFORMATION:

Full Name: *


Date of Birth: *


Gender: *
Female Male

Caravan Drivers: *
I am NOT able to drive to Gleanings I AM able to drive to Gleanings Count me as a back-up driver

Passenger Space:
0 passengers 2 passengers 3 passengers 4 passengers 5 passengers 6 passengers

T-Shirt Size: *
X-Small Small Medium Large X-Large XX-Large XXX-Large

CONTACT INFORMATION:

Mobile Phone: *


Texting:

Facebook:

Email: *


Address: *


City: *


Zip: *


EMERGENCY, MEDICAL & HEALTH INFORMATION:

Guardian Name: *


Guardian Phone: *


Guardian Email: *


Other Emergency Contact Name: *


Other Emergency Contact Phone: *


Do you have any medical conditions that might prevent you from fully participating in this missions trip that we should be aware of: *


Do you have any allergies: *


Are you presently taking any medications? If so, please list: *


Do you have Health Insurance? *
Yes
No

Who is your Health Insurance Provider?


What is your policy number?




FINANCIAL ASSISTANCE:

Are you interested in Financial Assistance? *
Yes
No

Out of $175, how much assistance will you need? *
$0 $25 $50 $75 $100 $125 $150 $175

Are you interested in sponsoring another person to go to Gleanings? *
Not at this time Yes, full sponsorship Yes, partial sponsorship

APPLICATION QUESTIONS:

I agree to get a Personal Reference in order to be considered for this team. *
Yes
No

I agree to participate with a positive attitude, be inclusive, follow the rules and be respectful at all times. *
Yes
No

I acknowledge that Gleanings is a service trip that requires my focus, hard work and willingness to follow the direction of the Gleanings leadership. I intend to do so without complaining or refusing to help. *
Yes
No

I acknowledge that Gleanings is a week-long trip. I am committed to stay with our team throughout the entire week. *
Yes
No
I am not available for the entire week, but I am still interest in joining the team to serve on this trip.

I agree to keep a teamwork attitude. *
Yes
No

As a student, I agree to keep my interactions with people of the opposite sex appropriate and platonic during my time at Gleanings. *
Yes
No

Briefly describe your Christian life experience in the following three catergories:

Before Christ: *


Conversion: *


Present Realationship: *


Have you ever participated in a missions trip? *
Yes
No

If so:

When did you go?


Where did you go?


What group did you go with?


Who was your leader?


What did you do?


Do you serve in any ministry or service opportunities wither inside or outside the church? *


Describe your church involvement: *


What are your gifts? *


What are the most significant events that have happened in your life over the past two years? *


Please briefly explain why you want to participate in this missions trip. *


What personal expectations or goals do you have for this trip? *


Do you have a life verse, favorite scripture or a bible passage that means a lot to you? Explain. *


What is an interesting fact about you that most people don't know? *