Individual Application

Medical Information
Gender*

MaleFemale
Do you have any medical conditions, physical limitations, disabilities, etc.?*

YesNo
If yes, please explain
List any allergies (food, medicine, etc.)
List any current medications
Do you regularly use any of the following?*

Narcotic DrugsTobaccoAlcoholic BeveragesNone
Primary Health Insurance Carrier*
Policy Number*
In case of emergency, please contact*

First NameLast NsameRelationship
Phone Number*

Country CodeArea CodePhone Number
Secondary In case of emergency, please contact*

First NameLast NsameRelationship
Phone Number*

Country CodeArea CodePhone Number

Ministry Information
How did you hear about this mission opportunity?*
Why do you want to be involved with this particular experience?*
Please list any international or cross-cultural experiences you have had.
Please list any experience working with babies, children or teens.
What is your local church affiliation?*
Pastor/Priest/Leader's Name*
Church Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Country CodeArea CodePhone Number
When did you trust Jesus Christ as your personal Lord and Savior?*
Have you been baptized?*

YesNo
Please share how you came to know Christ personally.*
What is your approach to spending time alone with God?*
Please explain a difficult experience you have faced, and how knowing Christ impacted that experience.*
What are your top three prayer requests concerning your involvement with this mission trip?
1.*
2.*
3.*
Are you willing to be a representative of Jesus Christ and Livada Orphan Care during your time of service?*

YesNo
Are you willing to submit to the authority of the Livada Orphan Care/Fundatia LOC staff, with whom you will be working?*

YesNo
Due to the nature of this minstry, and for the protection of the children we serve, are you willing to sumit to a background check?*

YesNo
Electronic Signature*
By typing your name and clicking submit you agree to complete accuracy within this application. A paper medical release, payment policy and code of conduct contract will be required once your application has been accepted.
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Volunteer Application