Information Form for Short-Term Missions Trip (Please either copy and paste this into an email with your responses and attach a recent photo or print out this page and mail it in.) For a copy you can open, edit, and print: Right click here. and click "save as" and save to your computer, then open in Word or other word processing program to enter your information. Information sheets are required. We request them as soon as you are considering coming on this trip. Our address is: Craig and Celeste Welch Forms must be in at least 2 month prior to your visit. Forms are required for all working visitors and team members General Information: Name Address
Phone (___ ) ( ________) Email Address ________________________ Best way to contact (circle one) phone / email Age___________________ Are you a member of a local church? Yes No If so, include the following information. Church and Pastor’s Name _________________________________ Church Address Phone (___ )__________
Emergency Contact Information including email-
Do you have Emergency Evacuation Insurance (if so, include # and contact info)
Passport expiration date ______________________ Vaccines receive to date Hep A _______Hep B_________Typhoid _________Tetanus___________ (you do not need to take malaria medication or get yellow fever vaccine) Do you speak Spanish? ________If so, at what level do you speak________________ Any other languages (from time to time, the hospital needs translators)__________________.
List any health conditions that may hinder/inhibit your participation in Ecuador? (Keep in mind heat and altitude)
List any allergies (i.e. pollen, poison ivy, medications, food, etc.) _______________________________
List any past issues with anxiety or other emotional problems___________________________________ List all medications you are currently taking.
Questionnaire: Answer the following questions.
Why are you interested in serving with us?
Explain your salvation experience.
Do you smoke or drink alcohol? ______ If so, how often? __________ (culturally, smoking is seen as something a Christian would not do. We ask that you do not smoke or drink while visiting Ecuador to serve with us)
Do you have skills in art, healthcare, therapy, ESL, or teaching?
What other skills do you have? (auto repair, cooking, computer/website work, photography, etc)
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List and explain three difficulties that you foresee having in this experience and how you may overcome them. 1.
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Book?
Hobby?
Song?
Color?
Food?
Have you traveled internationally before? _______To where? _______________In what capacity?
What is your favorite scripture and why?
What is the biggest hindrance in your relationship with the Lord?
What is God teaching you in your life right now?
Teaching 1 2 3 4 5 why? Servanthood 1 2 3 4 5 why? Encouragement 1 2 3 4 5 why? Bible Knowledge 1 2 3 4 5 why? Leadership 1 2 3 4 5 why? Flexibility 1 2 3 4 5 why? Discipline 1 2 3 4 5 why? Patience 1 2 3 4 5 why? Teachability 1 2 3 4 5 why? Working in a Group 1 2 3 4 5 why? Working Individually 1 2 3 4 5 why?
List one personal reference:
Address
Email: Release of Rights We live in a world that is full of rights. American culture is one where we take pride in our rights. The rights of individuals are constitutional; however, as we see the demanding of individual rights increase, we see more of the moral fiber of our society decrease. Our Lord Jesus Christ laid down His rights to the heavens and all His glory to become a man and to serve, not to be served. (Philippians 2:5-11; Mark 10:45) Consider laying down your rights on this mission trip. Not to lay them down for better or worse, but to entrust them to the Lord, or to transfer the responsibility of them to a place of safekeeping. These rights may seem reasonable but could still cause dissension on a short-term mission trip. Take time to search your heart and willingly surrender your rights to the Lord. Your words, facial expressions, and heart will say a lot to the people you are serving in Ecuador and could possibly ruin your Christian witness. Evaluate whether or not you are prepared to eat anything, smell anything, wear anything, sleep anywhere, and go without outside communication before arriving. Romans 12:1 I give up my right to: I entrust to God:
coffee my energy level
I give God permission to do anything He wishes to me, with me, in me or through me, which would glorify Him.
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