Short Term Mission Trip Group Application

What mission trip or program are you applying for?*

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

Name*

First Last

Nickname/Preferred Name

Gender

Male
Female

Address*

Street Address City State ZIP Code

Email*

Phone*

Additional Phone

Best Time To Call

Time and Day of the Week

Church Information

Your Role

Pastor
Leader
Attendee

Church Address

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

Pastor's Name

Church Phone Number

Church Website

Do you have a list of team members already?*

Yes
No

Do all your team members have up-to-date passports?

Yes
No
I Don't Know

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.

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*

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?