Short Term Mission Trip Application

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*

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*

Cell Phone*

Additional Phone

Best Time To Call

Time and day of the week

Are You Currently a Student?*

Yes

No

What Grade/Year?*

T-Shirt Size

Passport & Family

Do you have a passport?*

Yes

No

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

Home Church Information

Home Church Name*

Church Denomination*

Church Address*

How Long Have You Attended?*

Church Phone

Church Website (If it has one)

Partnered With Us Before?

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

Yes

No

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*

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

Today's Date

MISSION TRIP APPLICATION

Group Leader

Personal Information

Applicant Parent(s)/Guardian(s)

Church Information

Participant List

Passport & Family

Agreement

Home Church Information

Health

Partnered With Us Before?

Emergency Contact

Agreement