Name *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Are you 21 years or older? *

Yes

No

Phone number *

(###)

###

####

I am currently part of a Gateway SERV team *

Yes

No

This mission trip may have standards of dress, conduct, and accountability. Are you willing to follow the missions guidelines and team leadership even though you might not totally agree with them in every situation? (We are speaking of a difference of opinion, not something unbiblical or immoral. ex: not allowed to wear earrings) *

Yes

No

I agree that if I do not raise enough financial support to cover the cost of this trip, I will be responsible to pay for it from my own reserves/savings.
 *

I agree

Have you ever been convicted of a felony or crime? *

Yes

No

Do you drink alcoholic beverages *

Never

Occasionally

Frequently

In the last 6 months have you used narcotics, hallucinogens, drugs or tobacco products not prescribed by a physician? *

Yes

No

Do you have any significant health issues, physical limitations or disabilities that may affect your ability to participate fully in the mission or would require accommodations in order to take part? *

Yes

No

In the last 12 months have you had any incidents of intentional self-injury or cutting yourself? *

Yes

No

In the last 6 months have you struggled with an eating disorder? *

Yes

No

Do you receive any on-going medical treatments? *

Yes

No

By checking "I AGREE," It means you have read the MISSIONS COVENANT (*attached below) and can faithfully commit to each requirement. *

I AGREE

By checking "I AGREE," it means that you have read the MISSIONS TEAM REQUIRED DATES (*attached below) and can faithfully commit to them, or have communicated any scheduling conflicts. *

I AGREE

By checking, "Yes", I understand that my application will remain invalid until I pay the $50 application fee (submit payment down below) and also attend the interest meeting. *

Yes

I have answered all questions honestly and to the best of my ability. *

Yes

No