Short-Term Missions Application

Leader of trip : Dates of trip :

Destination :

Agency/Organization Sponsoring Trip :

Trip Costs :

Airfare : Room :

Visa : Meals

Evacuation Insurance :

Other : Explain :

Explain :

Total :

Describe the trip goals and who they are to be accomplished by :

My responsibilites for this trip are :

Personal Information

Name :

Address :

Phone :

E-mail :

Passport # Name as it appears on passport :

Provide a photocopy of the signature and issue page of your passport. Please send it to Loudonville Community Church :

374 Loudon Rd. Loudonville, NY 12211.

Emergency Contact Information

Name : Phone :

Address :

E-mail :

Ministry Experience :

Member of LCC

Attendee of LCC - How long?

If no, what church do you attend ?

List any past missions trips you have taken:

List other ministry experience (ex., taught VBS at LCC in 2008)

Spiritual Life

Have you accepted Jesus Christ as your personal Savior? # of years

Please briefly tell us when and how you came to accept the Lord into your life.

Have you ever led anyone to accept Jesus Christ as Savior?

Please explain why you wish to go on this trip.

What do you feel is your spiritual gift (see I Corinthians 12, Romans 12)?

How would you like to grow personally from this trip?

LCC Short-Term Missions Personal Statement of Faith

• I believe the Bible to be the inspired, the only infallible, authoritative Word of God. (2Timothy 3:16)
• I believe that there is one God, eternally existent in three persons: Father, Son and Holy Spirit. (Ephesians 4:4-6, 1 Corinthians 12:4- 6, 1 Peter 1:2)
• I believe in the deity of our Lord Jesus Christ, in His virgin birth, in His sinless life, in His miracles, in His vicarious and atoning death through His shed blood, in His bodily resurrection, in His ascension to the right hand of the Father, and in His personal return in power and glory.
• I believe that for the salvation of lost and sinful man, regeneration by the Holy Spirit is absolutely essential. (Titus 3:5)
• I believe in the present ministry of the Holy Spirit by whose indwelling the Christian is enabled to live a godly life. (Galatians 5:22-23)
• I believe in the resurrection of both the saved and the lost; they that are saved unto the resurrection of life and they that are lost unto the resurrection of damnation. (Revelation 20:12-13)
• I believe in the spiritual unity of believers in our Lord Jesus Christ. (1 Corinthians 12:4-6ff)

Signature : Date :

Skills you have that can be used on this trip:

Carpentry Electrical

Plumbing Puppets

Clowning Instrument

Voice Song Leading

Language

Other

How would you describe your health?

Comments :

I do not have any health conditions which would hinder or prevent my participation in this missions trip.

I take prescription medication.

I have allergies: Please list.

Name of Health Insurance Company :

Policy Number :

Financial Support

You are required to raise funds through recruiting supporters or make a personal donation to cover the cost of this trip. Do you agree to raise or contribute to the full amount?

Prayer Support

Additionally, you will need to recruit eight prayer partners. List those eight people and indicate those who attend Loudonville Community Church by placing an asterisk (*) by their name.

Waiver

If accepted for this trip, I will particiapte voluntarily and of my own free will. I will not hold trip leaders, the sponsoring missions board, missionaries or LCC responsible for any accident, injury, illness or other personal loss that might result from this trip. I authorize trip leaders as my agents to consent to any emergency treatment that is necessary in the case of accident or illness which is deemed advisable. I will submit to trip leadership and maintain a cooperative spirit in all activities. To the best of my ability, I will participate in trip preparation and evaluation sessions. If I am receiving disability benefits, I will provide a letter from a physician stating activites in which I can participate. If I do not have health insurance coverage, I agree to purchase a policy specifically for this trip.

Signature: Date :

Parent Signature (if under 18): Date :