2023 Bread ofTrip Application

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Spo

Please print name as it appears on your passport:

First Name *

Middle Name *

Last Name

Street Address *

City *

State *

Zip Code *

Cell Phone *

Home Phone

Email Address *

Gender

Clear selection

Passport #: *

If you don't have a passport, please use asterisks.

Expiration Date of Passport

YYYY

Issue Date of Passport

YYYY

Birthdate *

YYYY

Age

Place of Birth *

Marital Status *

Single

Married

Divorced

Widowed

If under 18 years of age, name of parent(s) or guardian(s) and their cell phone #.

Which church do you attend? *

Are you currently serving in ministry? If so, where? *

Have you served in missions before? (If yes, please include location and general dates.) *

Do you have a personal relationship with Jesus? *

Yes

If so, please briefly summarize your testimony.

I am gifted in the areas of: *

(Please check all that apply.)

Leadership

Prayer

Teaching

Children's Ministry

Writing

Healthcare

Language

Video

Photography

Construction

Drama

Administration

Accounting

Music

Other:

Required

Why would you like to participate in this mission trip? *

What would you like to accomplish on this trip? *

Describe what you think may be the biggest challenge for you to overcome for this project: *

Describe your strengths: *

Describe your weaknesses: *

Do you have a criminal record? If so, please explain. *

Please list any medications that you are currently taking, doctor's restrictions you are under, or any medical condition(s) that could affect your health and well being on the trip (including pregnancy).

I understand that this trip is an evangelical Christian mission trip and understand that I will be expected to share my faith with others as part of this trip. *

Yes

Required

If I am chosen to be part of this team, I commit to the following: *

Prayer and Bible study daily

Send out letters to raise a support team for prayer and finances

Attend all training and follow-up meetings before and after the trip

Be financially responsible for the trip and complete payments one month prior to departure

Walk in integrity

Honor the guidelines and expectations set forth by the host missionary, team leader, and Bread of Life Mission

Required

Insurance and Medical Information

Insurance Provider

Insurance ID#

Insurance Address

Insurance Phone #

Insurance Policy Holder

Employer Providing Policy (if group policy)

Employer Phone # (if providing group policy)

Employee Position

Insurance Group #

All team members should be up-to-date on routine vaccinations while traveling to any destinations. Some vaccines may also be required for travel.

I understand the US Center for Disease Control has immunization requirements by country listed on their website (http://wwwnc.cdc.gov/travel/destinations/traveler/none/kenya).

I have reviewed the immunization requirements for my country of travel on the CDC website and attest that I have or will obtain the necessary immunizations prior to leaving on our trip.

I authorize the mission team to make medical decisions for me if I am unable to speak for myself.

Required

Emergency Contact Information

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Address *

Emergency Contact Cell Phone *

Emergency Contact Home Phone

Emergency Contact Email Address *

References

Name of Pastor or Spiritual Leader *

Church *

Phone # *

Name of Personal Reference *

Relationship *

Phone # *

Statement of Faith

IN THE ESSENTIALS WE BELIEVE IN UNITY *

There is one Body and one Spirit, there is one Lord, one faith, one baptism, and one God and Father. (Ephesians 4:4-6)

Yes

IN THE NON-ESSENTIAL BELIEFS, WE HAVE LIBERTY *

Accept him whose faith is weak, without passing judgment on disputed matters. Who are you to judge someone else's servant? To his master he stands or falls...so each of us will give an account of himself to God... So whatever you believe about these things keep between yourself and God. (Romans 14, 4, 11-12, 22)

Yes

THE ESSENTIALS WE BELIEVE *

The sole basis for our belief is the Bible, which is uniquely God inspired, without error, and the final authority on all matters on which it speaks. As the Bible teaches, there is one God, eternally existing in three persons – Father, Son and Holy Spirit – each possessing all the attributes of deity. God created humans to have fellowship with Him, but they have defied God by going their own way. As a result, we need God’s saving grace to end our alienation from Him. Salvation comes only through God’s grace – not human effort – and must be received personally by repentance and faith. Jesus Christ, second person of the Trinity, lived a sinless life on earth and voluntarily paid for our sins by dying on the cross as our substitute. This accomplished salvation for all who receive grace by trusting in Him alone. He rose from the dead and is the only mediator between us and God. He baptizes believers in the Holy Spirit. He will return to earth to consummate history. The Holy Spirit draws sinners to Christ and equips believers for personal growth and service to the church. The church’s role is to glorify God and serve those in need. At the end, everyone will experience bodily resurrection and the judgment. Only believers will enjoy eternal fellowship with God.

Yes

My initials below indicate the following: *

I have read the above statement of faith and have circled my own view on these issues. In addition, all information in this application is true and complete. I also authorize Bread of Life Mission to make such inquires into related matters as may be necessary in arriving at an acceptable decision. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application in accordance with the liability waiver linked below.

YYYY

By checking this box, I certify that I have read and agree with the Liability Waiver linked below. *

Yes

Required

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