Mission Trip Application 2024
This is a sign up/commitment to going on the short term mission trip you select
This form does not include Youth Mission Trips
Please look for our student ministry applications on our website at centralbcs.org/life-stages/students
Your Name
*
Mr.
Mrs.
Miss.
Prefix
First Name
Last Name
Email Address
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
Date
Emergency Contact Info
*
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relation To Emergency Contact
Have you been on a Central Mission Trip Previously (This can include youth)
Yes
No
Do you have a Passport?
*
Yes
No
Its processed and on it's way
I have an appointment scheduled
Passport Number (If you already have one)
Passport Date of Issue
-
Month
-
Day
Year
Date
Passport Expiration Date
-
Month
-
Day
Year
Date
Passport Nationality
Which Mission Trip Are You Applying For? This is a commitment. You Can Select Multiple
*
Syracuse New York, July 20th-26th
San Marcos, College Only October 3-8th
Dublin Ireland, December 14th-21st
El Salvador, July 20th-26th
El Salvador, August 31- Sept 6th
Syracuse New York, College Only October 3-9th
Write a short testimony
*
What is the Gospel?
*
Are You a Member at Central?
*
Yes
No
I am a college student and I go to One80
I am a college student and haven't found a church/I go to a different church
Back
Next
Have you taken a ministry safe/child protection course?
Yes and it is valid for 2024
No
yes, but my previous one might be expired
Do you have a criminal record? (this does not automatically make you ineligible)
Yes
No
The Name of a Non-Family Member Reference
*
First Name
Last Name
Reference Email
*
example@example.com
Submit
Should be Empty: