Liberty Trip Application

Liberty Trip Application
What Trip are you applying for?
Date of Trip
Personal Information
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Birth Date

MonthDayYear
Gender
Marital Status
Have You Been on Trip with Liberty Before
If yes, When/Where
Phone Number

Area CodePhone Number
Mobile Number

Area CodePhone Number
Describe Your Health
Please list any anxiety disorders, or mental health behaviors that will be helpful for the team leaders to know. This will not be shared with anyone except the team leader and missions pastor. Examples but not limited to are Bipolar, anxiety attacks, Asperger’s Syndrome, PTSD, or depression.
Are you current taking any medications? If so please list them here.
References

Please Provide one pastor for reference and one non family member
Reference 1
Phone Number

Area CodePhone Number
E-mail
Reference 2
Phone Number

Area CodePhone Number
E-mail
Church Background and Salvation
Please share a bit of your story of when and how you came to know Christ and gave your life to fully follow Him.
I attend Liberty
Which campus do you attend?
If you do not attend Liberty where do you attend?
Could you please share some ministries you are currently involved with?
How do you plan to pay for this trip?
What We Believe
The following represents the beliefs of Liberty and the Missions Ministry. If you agree check the last box that says "Agree with All" If there are any exceptions, list those below. Exceptions do not necessarily mean you will not be able to go with Liberty on this trip.
I have read the doctrinal statements of Liberty and am in agreement with all except the following exceptions ( If Any) .
Date form submitted

MonthDayYear
Should be Empty:

Liberty Trip Application

Personal Information

References

Church Background and Salvation

What We Believe