Your Email*

Trip Information

Please enter your team name (usually your church)*
Trip Location*
  • Calgary
  • El Salvador
  • Guatemala
  • Haiti
  • Honduras
  • Navajo Nation

Please be sure to select the correct trip start date, it's how we organize our trips!

If you are unsure of your trip start date please contact your team leader or Cathi@Lifeline.org

Please list any family members going on this trip
What is your nearest major airport? (If you are not flying please type "None")*
Is this your first Lifeline Mission Trip?*
  • Yes
  • No
Have you participated in any other mission trips? If so, where?

Personal Information

If you have a preferred name (other than your legal name), what is it?
Cell Phone Number*
Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Spouse Name
Spouse Phone Number
Emergency Contact Name*
Emergency Contact Relation*
Emergency Contact Phone Number*
Emergency Contact Email (Person to be notified upon your arrival in the field)*

Passport Information 

Please use your name as it appears on your passport or birth certificate. 

First Name*
Last Name*
Middle Name (If you don't have one/it is not listed on your passport please write "N/A")*
Date of Birth (MM/DD/YYYY)*
Confirm Date of Birth (MM/DD/YYYY)*
Gender*
  • Female
  • Male
Passport Number
Confirm Passport Number
Passport Expiration Date (MM/DD/YYYY)
Passport Country of Issue

Experience Information

Please indicate the level of experience you have with the categories below.

If you have no experience you may leave the question blank. 

Music/Worship (Please select any instruments you play in addition to experience level)
  • Some
  • Extensive
  • Professional
  • Bass Gutair
  • Drums/Percussion
  • Guitar/String Intruments
  • Keyboard
  • Singing
  • Wind/Brass Instruments
Please list and describe any other skills

Church Affiliation and Trip Expectations

Home Church*
Please share how you became a Christian
What are your goals/expectations for this trip?*
Please list any prayer requests - We at Lifeline will pray for these during your trip

Health and Medical Information

Blood Type (if known)
Health Concerns
  • Back Problems
  • Diabetes
  • Epilepsy
  • Heart Problems
  • High Blood Pressure
  • Other (Please describe below)
If you selected 'other' above, please describe your health concern
Please list any allergies (including food allergies/sensitivities)
Please list surgical history
History of depression or mental health problems (please include details)
Are you currently under doctor's care? If so, why?
Please list all current medications
Please list any physical limitations

Releases and Agreements

I have submitted my passport copy and notarized release form to my Team Leader*
  • Yes
  • No

I recognize that by participating in this short-term mission trip I agree to abide by the rules and policies within the Team Member Handbook. 

I agree*
  • Yes
  • No

Lifeline Christian Mission uses photos and videos of workteam members in printed materials and on our website.  

I give my permission to Lifeline to use any photos and videos of me taken in the mission field*
  • Yes
  • No
Please share any notes, comments, or concerns.
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