Participant Application This form is to be filled out by mission trip participants who are coming as part of an already registered group. Each person in the group is required to fill out this form at least 30 days before your trip. If you are an individual or family looking at coming on a mission trip and do not have a team to come with, please note that where it says "Group Name" and "Group Leader". This Application Form is an integrated agreement that consists of the fields set forth below, the attached Liability Waiver, and the attached Team Member Commitment. If you are having any difficulties filling out this form, please notify your team leader or local STM coordinator.Outreach Location*ChooseClarkston/AtlantaRichmondHouston10/40 Window TripOtherGroup InformationYour Group's Name*Please write "individual" or "family" if you are not coming with an established group.Are you the Team Leader?*ChooseYesNoDo you agree to ensure that your team meets financial and participant form deadlines and to facilitate all pre-field training required?*GFM staff will be in contact with the necessary pre-field training materials.I AgreeWhat is the Size of your Group?What is your group leader's name?Mission Trip DatesFrom* Date Format: MM slash DD slash YYYY To* Date Format: MM slash DD slash YYYY General InformationFull Name*(As it appears on passport.) Preferred First Name or Nickname* Age*Gender*MaleFemalePermanent Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone Number*(xxx)xxx-xxxxE-mail Address* Church InformationDo you regularly attend a local Christian church?*YesNoIf not, why?*What's the name of your church?*Church Denomination*(if applicable)Personal InformationHave you committed your life to Jesus Christ?*YesNoPlease write a paragraph explaining how you came to know the Lord and describing your present relationship with Him:*Have you ever been on a Christian mission trip before or do you have any missionary experience? Please describe below:*Are you currently engaged in any ongoing behaviors that are contrary to biblical teaching?*YesNoIf Yes, please describe below:*Do you agree with GFM's Statement of Faith?*Statement of FaithYesNoPlease share your expectations of this short-term mission exposure?*Who can we contact in the event of an emergencyEmergency Contact's First and Last Name* Relationship to you*Contact Phone #*(xxx)xxx-xxxxContact E-mail Address Participant's Medical Insurance InformationDo you have Medical Insurance?*YesNoInsurance CompanyGroup NumberPolicy NumberIn whose name is the insurance?Participant's Medical InformationPlease be accurate and specific!Name of Family Doctor City and State/ProvinceDoctor's Phone Number(xxx)xxx-xxxxHospital and medical records for this participant are located at:Please list all prescription medications you are bringing on the trip:MedicationDosage Please describe any allergies you have to medications:*Please describe any other allergies/intolerences you have (food, gluten, etc.):*Note: GFM cannot accommodate all food allergies. You may be required to bring or purchase your own food.Please describe any current or pre-existing health problems/medical conditions (i.e. migraines, asthma, chest pains, seizures, etc.):*Please describe any physical activity limitations you have:*Additional Comments :SignaturesThe following MUST be completed and signed by either the participant or a parent/legal guardian of the participant if participant is under the age of 18 years old: By signing below, I affirm that I am the participant named above and am at least 18 years old, or that I am the natural parent or legal guardian of the participant named above and that I give permission for the participant to attend and participate in the Global Frontier Missions function specified above. I further affirm that the above information is true, accurate, and complete to the best of my knowledge, and I affirm that I have read and agree with the Waiver of Liability and Consent Form. By signing below, I affirm that the above information is true and accurate to the best of my knowledge, and I affirm my acceptance of the Team Member Commitment. I have read and agree to abide by the Global Frontier Missions' Code of Conduct. I understand that if I violate this Code of Conduct I will subject to a range of consequences, up to and including being prohibited from participating in any activities or programs of the organization.Your Full Name Relationship to Participant(if participant is under 18) Electronic Signature (Your Full Name)*Date* Date Format: MM slash DD slash YYYY I would like to receive follow up emails for further teaching after my trip with GFMAs part of our comprehensive training experience, we will send 5 emails over 30 days. These will help you remember the teachings you received and implement them in your life. You may unsubscribe at any time. Yes PhoneThis field is for validation purposes and should be left unchanged.