Mission Trip Application

"*" indicates required fields

Start Year*

Individual or Group Application?*

Outreach/Program*

Church/Organization*

How Many People Do You Anticipate Bringing?*

At this point an estimate – i.e., “10-12” or “35-40” – is fine.

Group Leader

Choose someone we will be able to communicate with leading up to your outreach

Full Name*

First Last

Nickname/Preferred Name (Optional)

Gender*

Date of Birth*

Email*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone*

Additional Phone

Best Time To Call

Time and day of the week

Personal Information

Full Name*

First Last

Nickname/Preferred Name (Optional)

Gender*

Date of Birth*

Email*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone*

Additional Phone

Best Time To Call

Time and day of the week

Are You Currently a Student?*

Yes

What Grade/Year?*

T-Shirt Size

Applicant Parent(s)/Guardian(s)

Are You Under 18 Years Old?*

Yes

Parent/Guardian Full Legal Name*

First Last

Parent/Guardian's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Guardian Cell Phone*

Parent/Guardian Other Phone

Church Information

Your Church Role

Pastor

Leader

Attendee

Other

Church Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Pastor's Name

Church Phone Number

Church Website

Do All Your Team Members Have Up-To-Date Passports?

Yes

IMPORTANT: Every team member must have a passport if your outreach is outside the country. It typically takes 6 to 8 weeks to get a new passport.

Do You Have a List of Team Members Already?

Yes

Participant List

A participant list to be filled out by the group leader. Please note that by listing people on the participant list you are indicating to us that you not only recommend them for this outreach but that you agree to offer general leadership to them within the context of the outreach. Please only list people that you believe are:

Christians living under the lordship of Jesus.
Physically and emotionally suited for this outreach.
Willing to listen to and follow instructions.

Participant List

Full Name

Gender

Birth Date

T-Shirt Size

Any Known Medical Conditions?

Student or Adult Leader?

Passport & Family

Do you have a passport?*

Yes

You must have a passport if your outreach is outside the country. It typically takes 6 to 8 weeks to get a new passport.

Martial Status

List full name, age, schooling grade level and gender of any children that would be accompanying you

Name

Age

Grade

Gender

Agreement

I certify that all information in the application is complete and accurate. I consent to communication with YWAM Louisville including emails and phone calls. Please type/sign your full name to certify your agreement.

Type Full Name to Certify Your Agreement*

Date of Certification

MM slash DD slash YYYY

Home Church Information

Home Church Name*

Church Denomination*

Church Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long Have You Attended?*

Church Phone

Church Website (If it has one)

Health

If Necessary, Are You Able To Walk 3-4 Miles Per Day?*

Yes

Are Your Hepatitis A and Tetanus Shots Up To Date?*

Yes

Health Insurance Provider

Insurance Policy Number

Do You Have Any Known Allergies?*

Yes

Please List Allergies*

Do You Have Any Other Health Issues, Medical Conditions, or Physical Handicaps, or Are You Currently Under a Doctor’s Care For Any Condition?*

Yes

If Yes, Please Describe:*

Are You Taking Any Medication At This Time?*

Yes

If Yes, Please Describe:*

Do You Have a History of Emotional Instability or Psychiatric Treatment?*

Yes

If Yes, Please Describe:*

Please List Any Special Circumstances or Situations We Should Know About

Partnered With Us Before?

Have You Ever Been Involved in a Mission Trip, Missions Training Program, or Any YWAM Function?*

Yes

What Mission Trip or Program?*

Leader's Name*

Which Ministry or YWAM Location Did You Work With?*

Date Attended (Year and Month)*

Emergency Contact

Name(s)*

Relationship to Participant*

Phone Number*

Additional Phone Number

Agreement

I certify that all information in the application is complete and accurate. If accepted by Youth With A Mission, I will abide by the spirit, rules, and schedule of the program. I understand that my file are YWAM property, and I relinquish the right to view them or obtain information from them in any way.

Please Type Your Full Name to Certify Your Agreement.*

Today's Date*

MM slash DD slash YYYY

Parent/Guardian Type Full Name to Certify Their Agreement (If Applicant Under 18)

Today's Date

MM slash DD slash YYYY

MA Application Form

"*" indicates required fields

Start Year*

Individual or Group Application?*

Outreach/Program*

Church/Organization*

How Many People Do You Anticipate Bringing?*

At this point an estimate – i.e., “10-12” or “35-40” – is fine.

Group Leader

Choose someone we will be able to communicate with leading up to your outreach

Full Name*

First Last

Nickname/Preferred Name (Optional)

Gender*

Date of Birth*

Email*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone*

Additional Phone

Best Time To Call

Time and day of the week

Personal Information

Full Name*

First Last

Nickname/Preferred Name (Optional)

Gender*

Date of Birth*

Email*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone*

Additional Phone

Best Time To Call

Time and day of the week

Are You Currently a Student?*

Yes

What Grade/Year?*

T-Shirt Size

Applicant Parent(s)/Guardian(s)

Are You Under 18 Years Old?*

Yes

Parent/Guardian Full Legal Name*

First Last

Parent/Guardian's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Guardian Cell Phone*

Parent/Guardian Other Phone

Church Information

Your Church Role

Pastor

Leader

Attendee

Other

Church Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Pastor's Name

Church Phone Number

Church Website

Do All Your Team Members Have Up-To-Date Passports?

Yes

IMPORTANT: Every team member must have a passport if your outreach is outside the country. It typically takes 6 to 8 weeks to get a new passport.

Do You Have a List of Team Members Already?

Yes

Participant List

Christians living under the lordship of Jesus.
Physically and emotionally suited for this outreach.
Willing to listen to and follow instructions.

Participant List

Full Name

Gender

Birth Date

T-Shirt Size

Any Known Medical Conditions?

Student or Adult Leader?

Passport & Family

Do you have a passport?*

Yes

You must have a passport if your outreach is outside the country. It typically takes 6 to 8 weeks to get a new passport.

Martial Status

List full name, age, schooling grade level and gender of any children that would be accompanying you

Name

Age

Grade

Gender

Agreement

Type Full Name to Certify Your Agreement*

Date of Certification

MM slash DD slash YYYY

Home Church Information

Home Church Name*

Church Denomination*

Church Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long Have You Attended?*

Church Phone

Church Website (If it has one)

Health

If Necessary, Are You Able To Walk 3-4 Miles Per Day?*

Yes

Are Your Hepatitis A and Tetanus Shots Up To Date?*

Yes

Health Insurance Provider

Insurance Policy Number

Do You Have Any Known Allergies?*

Yes

Please List Allergies*

Do You Have Any Other Health Issues, Medical Conditions, or Physical Handicaps, or Are You Currently Under a Doctor’s Care For Any Condition?*

Yes

If Yes, Please Describe:*

Are You Taking Any Medication At This Time?*

Yes

If Yes, Please Describe:*

Do You Have a History of Emotional Instability or Psychiatric Treatment?*

Yes

If Yes, Please Describe:*

Please List Any Special Circumstances or Situations We Should Know About

Partnered With Us Before?

Have You Ever Been Involved in a Mission Trip, Missions Training Program, or Any YWAM Function?*

Yes

What Mission Trip or Program?*

Leader's Name*

Which Ministry or YWAM Location Did You Work With?*

Date Attended (Year and Month)*

Emergency Contact

Name(s)*

Relationship to Participant*

Phone Number*

Additional Phone Number

Agreement

Please Type Your Full Name to Certify Your Agreement.*

Today's Date*

MM slash DD slash YYYY

Parent/Guardian Type Full Name to Certify Their Agreement (If Applicant Under 18)

Today's Date

MM slash DD slash YYYY