Mission Trip Application
Acts 1:8 (NIV) "But you will receive power when the Holy Spirit comes on you; and you will be my witnesses in Jerusalem, and in all Judea and Samaria, and to the ends of the earth."Note: This application must be completed in one setting. No ability to be saved.
What mission trip are you applying for?
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Please Select
Samaritan's Purse Rebuild Project: April 14-21, 2018
Name: Enter your name as it appears on your passport and/or birth certificate.
First Name
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Middle Name
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Last Name
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Suffix
Gender
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Male
Female
Phone Number
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Area Code
Phone Number
Email Address
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Date of Birth
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Month
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Day
Year
Date Picker Icon
Age
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If under 18 years of age, Name of Parent/Guardian
First Name
Last Name
Parent/Guardian Contact Phone Number
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Area Code
Phone Number
Do you have a criminal record?
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Yes
No
If yes, please explain:
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Lifepoint Church Involvement
In order to apply for a Lifepoint mission trip, you MUST be serving, in a lifegroup or tithing at Lifepoint Church.
What campus do you attend at Lifepoint?
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Fredericksburg
Spotsylvania
Stafford
Culpeper
Richmond
King George
What team are you actively serving in?
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Reference 1: Serving Team Leader Name & Email
Required: Upon application submission, you will be sent a reference link. Email the link to your leader and have them fill out the Mission Trip Leader Reference Form.
Are you in a small group?
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Yes
No
Reference 2: Group Leader Name & Email
Required: Upon application submission, you will be sent a reference link. Email the link to your leader and have them fill out the Mission Trip Leader Reference Form.
Do you currently tithe?
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Yes
No
Reference 3: Team Member, Friend, Other Name & Email
Required: Upon application submission, you will be sent a reference link. Email the link to your leader and have them fill out the Mission Trip Leader Reference Form.
Have you served in missions before?
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Yes
No
If yes, list the church/organization and trip location(s):
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Personal Information
Please explain why you want to go on this mission trip:
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Briefly summarize your personal testimony:
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How does your spouse/family feel about your participation in this trip?
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Do you have financial resources to pay for this trip? If not, explain your plan for gathering the needed finances:
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Health Information
Are you pregnant, do you have a physical or mental handicap, disability, or disease that might affect your ability to travel or serve on the mission trip?
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Yes
No
If yes, please explain:
Do you have any chronic illnesses?
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Yes
No
If yes, please explain:
Have you received counseling or therapy in the past two years?
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Yes
No
If yes, please explain:
Are you currently on medication prescribed by a doctor?
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Yes
No
If yes, please explain:
Please list any medication or food allergies you may have:
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Returning Applicants
Previous Lifepoint Mission Trips only
Why are you interested in serving on another Lifepoint mission trip?
What was the most significant challenge of your previous mission trip?
How has serving on a Lifepoint mission trip impacted your life?
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Signature & Upload Picture Here
I am committing to the following:
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Attend and participate in team meetings
If selected on the team to pay in full or complete fundraising
Honor the empowered team leaders
Respond to emails, phone calls or messages from team leaders
By digitally signing below, I indicate that all information given on this application is accurate and complete, to the best of my knowledge. Late applications will not be accepted for any reason.
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Upload Photo Here
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Submit
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