Lighten a Child's Future - Application Trip

Country*

Date*

Date

Full Name*

Age*

Gender*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Number*

Area CodePhone Number

Business Number

Area CodePhone Number

Cell Number

Area CodePhone Number

Email

example@example.com

Date and Place of birth*

mm/dd/yyyy , City,Country

Marital Status*

MarriedSingleDivorcedOther

Occupation*

Emergency Contact Full Name

Emergency Contact Phone Number

Area CodePhone Number

If you attend church, where?

Pastor's Name

Pastor's Phone Number

Area CodePhone Number

Do you have a valid Passport?

Have you ever been on a missionary trip before, or a trip to any other foreign country?

YesNo

If yes, what country and with whom?

Do you have talents you can use on this trip? Do you sing, play a musical instrument, teach, preach, or lead a children’s ministry?

Do you have carpentry, building or technical skills, or any medical or dental experience/skills?

Are you an Ordained Pastor, Minister, Missionary or Bible Teacher?

Check the areas of work/ ministry that you would be interested in helping (you may check more than one)

Do you have any difficulty in submitting yourself to leadership, men’s or women’s?

Do you love working with people?

Are you willing to work hard?

When things don’t go “as planned,” are you easily upset?

Are you in good health?

Do you have or have you ever been under a doctor’s care for heart Problems, diabetes, breathing problems, difficulty in walking, back problems or any other serious illness?

Are you taking medication at the present time?

If so, for what?

I am enclosing a $100.00 (check)

I am enclosing a$100.00 (cash)

I am enclosing a $100.00 (money order)

1. In the event I am not able to raise all the money needed for the missionary trip, any portion already submit- ted to Lighten A Childs Future Foundation Inc. is not refundable. If only a portion of the money needed is raised, it will remain in a special account for me for up to six months; in that period of time, I can use the money towards another trip. After that period of time, if I cannot go for any reason, the money will return to the General Missions account.

2. I further understand that there could be a possibility of the trip being postponed due to hurricanes and/ or other unpredictable forces of mother nature or that political problems or “unrest” within the country could mean possible danger to team members. In that event, the trip would be postponed to a later date and the team members could choose the next available trip to that particular country.

3. Lighten A Childs Future Foundation Inc. is not responsible for any articles lost or stolen or damaged before, after or during the trip. I understand that Lighten A Childs Future Foundation Inc. is not responsible for any accidents, sickness or illnesses that may result from this trip or any sickness, illness or accident that may occur during the trip or may be a result from the missionary trip.

4. In the event of sickness, accident or illness overseas requiring medical help, doctor’s care or hospitalization, I understand that I am fully responsible for all medical, hospital and doctor’s fees.

5. I hereby give permission to Lighten A Childs Future Foundation Inc. to use any audio or video recordings, photos or interviews in promoting their missions outreach, either through radio, television or printed materials.

6. I have read the application and agree to take the prescribed medications and abide by the rules. I have no physical problems which would hinder me from going, from walking or participating in any way.

Yes, I understand

Tee-Shirt Size*

SNLXL