327689351 Untitled (PDF)




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First Fruit Haiti Mission Trip Form

Full Name:___________________________________
Birthday:____/____/_______

Sex: Male/Female

Street Address:____________________________________
City:_________________________
State:______ Zip code:______________
Phone number:_______________________________ (home/cell/work)
________________________________ (home/cell/work)
E-mail address:___________________________________
Church you attend/church background:_______________________________________
______________________________________________________________________
Health Concerns (please explain):___________________________________________
______________________________________________________________________
______________________________________________________________________
Dietary Restrictions or Preferences: _________________________________________
______________________________________________________________________
Previous missions experience (in or out of country):_____________________________
______________________________________________________________________
______________________________________________________________________

Reasons for wanting to go on this trip:_______________________________________
______________________________________________________________________
______________________________________________________________________
Skills/talents/interests/knowledge that might be helpful on the trip:__________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Emergency Contacts:
Emergency Contact Person #1:
Name:__________________________ Relationship:____________________
Phone number:_________________________ (home/cell/work)
E-mail address:_________________________
Emergency Contact Person #2:
Name:__________________________ Relationship:___________________
Phone number:_________________________ (home/cell/work)
E-mail address:______________________

Participant’s Signature:______________________________
Date:____________________________






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