Short Term Mission Trip Individual Application

Outreach/Program Applying for

Personal Information

Legal Name*

First Last

Nickname/Preferred Name (Optional)

Sex*

Male
Female

Date of Birth*

Are you currently a student?

Yes
No

If yes, what year?

If other, please specify

T-shirt size

Mailing Address

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

Home Phone*

Cell Phone

Email*

Parent/Guardian Full Legal Name

First Last

Parent/Guardian Phone

Parent/Guardian Cell Phone

Do you have a passport?*

Yes
No

You will need a passport for our international mission trips.

Marital Status

List full name, age, schooling grade level and gender of any children accompanying you

Name	Age	Grade	Gender

YWAM/Mission Experience

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 center did you work with?

Date attended

Have you been involved in any other YWAM functions?

Church Information

Home Church*

How long have you attended?*

Church Address*

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

Church Denomination

Church Website

Pastor's Name

Church Phone*

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*