TRIP APPLICATION, part 1

Friends Forever  2009  Missions Trip

(attach your picture in the upper right hand corner – IT IS REQUIRED)
CLICK for part 2, part 3, part 4 and part 5

I.  Tell us about yourself.  (Please print legibly)

Full Name (as on Birth Certificate/Passport)

Last_______________________First____________________Middle________________

Passport Number____________________________Expiration Date_________________

Physical Address (no P.O. Box)______________________________________________

City________________________________State___________Zip__________________

Home Phone(_______)__________________Work Phone(_______)________________

Cell Phone(_______)___________________Email_______________________________

Birth Date_______/________/_________

Height________feet________inches       Weight_________pounds (do not leave blank)

(circle one)   Male     Female          T-shirt size:    S     M     L     XL      XXL

Marital Status:   Single     Engaged     Married     Separated     Divorced

                                                             Spouse’s Name_____________________________

II.  Tell us who you live with. (Please print legibly)

Father/Guardian

Last Name___________________________________First________________________

Phone(________)____________________Email________________________________

Mother/Guardian

Last Name___________________________________First________________________

Phone(________)____________________Email________________________________

If parents are separated or divorced, who has legal custody?

(circle one)    Father     Mother     Joint     Others_________________________________

III.  Please tell us if you have ever:

Been suspended or expelled from school?           5Yes            5No

Served time in a detention center or jail?             5Yes      5No

Been convicted of a crime?                                 5Yes           5No

Been involved with tobacco products?                5Yes            5No

Been involved with alcohol?                                5Yes            5No

Been involved with illegal drugs?                      5Yes            5No

Been involved with gang-related activities?      5Yes            5No

Been involved with a cult or the occult?               5Yes            5No

Had diabetes or hypoglycemia?                           5Yes            5No

Had fainting spells?                                              5Yes             5No

Had an eating disorder?                                       5Yes             5No

Had breathing problems?                                     5Yes             5No

Had psychiatric care?                                          5Yes             5No

Taken depressions or behavioral medication?       5Yes             5No




 

Trip Application, part 1

Page 2

Been sexually active? (omit if married)             5Yes             5No

Been pregnant or fathered a child?                   5Yes             5No

Been involved in homosexual activities?            5Yes             5No

Intentionally inflicted harm on yourself?            5Yes             5No

Attempted suicide?                                         5Yes             5No

Been treated for physical impairment?             5Yes             5No

Been treated for mental impairment?               5Yes             5No

If you answered “Yes” to any of the above, please give a complete explanation on a blank sheet of paper.

IV.  Give us your testimony by answering the questions below. (Please print legibly)

Date you made a commitment to follow Jesus________/________/________

                                                                          Month        Date          Year

Describe your current relationship with God:

Name of Home Church______________________________________________
 

(include city and state)_______________________________________________

Tell us how active you are in your church

Tell us why you want to go on this missions trip.

(use other side of page for writing space and answer in detail)


 

Trip Application, part 1

Page 3

Have you been on a missions trip before?____Where/Date:________________________

CIRCLE the 2009 week you are planning to participate"

Please Note 2009 Interns:

1. Your schedule on the first day will be to arrive in Montego Bay by June 20 or the 21st which is the start day of internship.  The facilities and staff of Friends Forever will not be available for any early arrivals.

2. All interns return day of your internship trip is July 16.  It is not the responsibility of Friends Forever to lodge Interns and/or non-employees after the day(s) of return to the USA.  If lodging accommodations/hotel reservations are needed for departure the next day,  it is done so at your own expense.

Authorization:

The information I have given above to Friends Forever Missions & Media aka Mark Muirhead Ministries, Inc. is accurate and true to the best of my knowledge. 

I agree to the responsibilities to uphold the ‘CODE OF CONDUCT’ for the missions trip week.  Additionally, I will take the online training to prepare myself for the trip.

I give Mark Muirhead Ministries, Inc. the right to use my picture, video taping and/or audio taping of me for broadcasting on Friends Forever TV and/or Around The World Radio and/or for promotional and/or advertising purposes. 

My enclosed signature (and signature of my parent or legal guardian because I am under the age of 18) signifies my approval.

Applicant’s Signature_________________________________Date_____/_____/_____

Parent/Guardian Signature_____________________________Date_____/_____/_____

                                    (required if applicant is under the age of 18)

Please return application with a $100.00 non-refundable and non-transferable deposit
before or by December 31, 2008.

Mark Muirhead Ministries, Inc. / P.O. Box 2001 / Pinehurst, NC 28370-2001

PH:  1-910-215-7777 / EM: harpmotive@aol.com