Mission Trip Registration

South Africa | 7/19/2024

Are you a high school student? Join some of Perimeter High School ministry as they partner with City Hope Church, located in the northern suburbs of Johannesburg, South Africa. While on the ground this team will connect with and serve some of their local partners who exist to develop their surrounding communities. From door-to-door prayer visits, running children’s programs, and some manual labor to engaging with and connecting and building gospel relationships with City Hope's student ministry.

Trip Dates:

7/19/2024 - 7/29/2024

Fundraising Goal:

$3,700.00

*First Name:

*Last Name:

*Country:

*Address Line 1:

Address Line 2:

*City, State, Postal Code:

*E-mail Address:

*Phone:

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

If a minor, Grade (if summertime, grade will you be going into in the Fall):

*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.

YesNo

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

PLEASE REVIEW AND SIGN THE RELEASE STATEMENT

I authorize Perimeter Church to contact all individuals and organizations listed on this form in order to verify the information I have provided. I agree to release from liability any person or organization that provides information related to me. I understand and agree that any information received from the screening process may not be disclosed to me except as required by law, and I hereby waive any right I may have to inspect any information provided about me by any person or organization identified by me on this form. I understand that I may withdraw from the application process at any time. By signing this form below, I certify and affirm that the information I have given on this form is true, complete and correct in all respects.

*Signature Name:

*Signature Date:

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