Mission Trip Registration

Tanzania|3/14/2019

Health screenings and science
3/14/2019 - 3/24/2019
$2,700.00

Additional Information

All minors must have at least one parent present for each training.
*Gender
Please enter date of birth in format mm-dd-yyyy
*Date of Birth
*In what country do you currently reside?
*Country of Citizenship
TSA Redress
PASSPORT INFO
*****Please enter your name exactly as it appears on your Passport.*****

*****If you DO NOT have a Passport, enter the name you will use when applying for your passport and enter “1” as your Passport Number.*****
*Passport First Name
Passport Middle Name
*Passport Last Name
Suffix
*Passport Number
*Expiration Date
EMERGENCY CONTACT
*Emergency Contact Full Name
*Relationship to Registrant
*Phone Number
CHURCH MEMBERSHIP INFO
*Perimeter Member Since (year)
*Perimeter Pastor's Name
*Perimeter Discipleship Leader Name
*Perimeter Activities
MEDICAL INFORMATION
*Do you have any medical conditions or take any medications which your team leader may need to be aware of as you participate on this journey?

If your response is yes, the GO Journey Coordinator will contact you to discuss how we can best accommodate your needs.
APPLICATION QUESTIONS
*Share a short summary of your spiritual journey.
*Describe any cross-cultural ministry experiences
*Describe what you hope to see the Lord do in and through you on this journey
*Who was the most influential in your decision to participate in a GO Journey?
GIFTS
Spiritual Gift 1
Spiritual Gift 2
Spiritual Gift 3
SKILLS
Skill 1
Skill 2
Skill 3
Other Skills
SAFETY FORM
The questions below are part of the process to help provide a safe and secure environment for our children.  We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy.
*Have you had any experiences that might make it difficult for you to minister to children/youth :
*Are you currently using illegal drugs:
*Have you ever been denied legal custody of your child(ren) in any legal proceedings including divorce decrees or settlements:
*Have you physically or sexually abused a child:
*Have you ever been accused or arrested for sexual molestation or physical or emotional abuse of child:
*Did you, as a child, experience any physical or sexual abuse that you have not yet processed in a healthy manner:
*Have you experienced any significant physical or emotional stresses within the past year, such as the loss of a parent, spouse, or child; extreme ill health; or any emotional or physical crisis:
*Are you currently engaged in any conduct or life pattern for which you are unrepentant or unwilling to stop:
*Do you have any health issues that could place the children of Perimeter at risk:
If you answered yes to any of the questions above in the Safety Form section, please explain. 
Please click 'Next' only once.  Do not click back to this page or you will be registered multiple times.