Footsteps Trip Application

Please fill out this application as completely as possible. * indicates required information.

Security


The password is used to edit registration if needed after you have submitted it. It can also be used to track your support through Support Tracking. Please keep the password safe.

*Password

*Re-enter Password


Personal Information


Please enter the name as it appears on your passport.

*First Name


Middle Name


*Last Name


*Street Address 1

Street Address 2

Street Address 3

*City

*State

*Zip Code

Age

*Birthdate
(YYYY-MM-DD)
Gender

Marital Status

Occupation

*Shirt Size

Home Phone

Cell Phone

Work Phone

Fax

*E-mail Address

Church Membership

Citizenship

Passport Number

Passport Expiration Date
(YYYY-MM-DD)

Trip Information



*Trip Destination



If you want to register for multiple weeks, select the first week of your trip here.
Roommate Request

Future Interest Country



Is there any country you are interested in serving in the future?
Insurance Information





Insurance Carrier

Group Number

Member Number

Phone Number

Fax Number



Emergency Contact



*Name

*Phone Number

*Relationship


Health Information

Do you have any health limitations that may require supervision? Do you require any medication?
Please describe any limitations that can affect different type of serving. If yes, please describe your condition and the medication type.


Immunization & Vaccination

For recommended vaccination, see the Center for Disease Control for the country you are going to.

Service Experience

What is your primary motivation for participating on this trip?

Please describe any prior servie you have done in the past.

Please describe any language training if applicable. List any other areas of christian service if applicable.
List the language, duration of the study and type of study. For example, sunday school teacher, youth leader, etc.




Do you sing? If so, which parts?

Do you play an instruments? If so, which ones and for how long?

Do you have any other talents or gifts that you think may be of assistance on this trip?