Warm Blankets Orphan Care International
Application – Cambodia Orphan Mission Trip 2007
Application – Mission Trip
Download the application form : Application_Form.pdf
Note: All persons who will have direct contact with children may also be asked to submit to a personal background investigation. If we feel that it is appropriate for the assignment for which you are applying, you will receive a written consent form under separate cover.
APPLICATION DATE:__________________
TRIP NAME:
____________________________
TRIP DATES:
____________________________
HOME ADDRESS
_____________________________________________________________________
(Street)
(City)
(State)
(Zip)
EMAIL ADDRESS
______________________@____________________________________
HOME PHONE (_____)
______-________ WORK PHONE (_____) ______-________
DATE OF BIRTH. _____/_____/____ SOCIAL
SECURITY NO. ______ -
______ - ______
PASSPORT NUMBER
___________________________ EXPIRATION DATE: _____________________
PERSONAL REFERENCE (not a relative)
______________________ PHONE (_____) ______-________
RELATIONSHIP / YEARS KNOWN ________________________________
ADDRESS_______________________________________________________________________________
(Street)
(City) (State) (Zip)
Height ___________ Weight ___________
How is your health
(circle one)?
Excellent
Good
Fair
Poor
Have you ever had any major physical ailments?
________Specify__________________________________
Do you require special medical or dental services? _____
Medication?_______
Specify__________
________________________________________________________________________________________
________________________________________________________________________________________
What foreign
languages do you speak, read, or write?
___________________________________________
IN CASE OF EMERGENCY NOTIFY THE FOLLOWING PERSONS:
NAME #1
_______________________________________________ PHONE (_____)
______-________
ADDRESS________________________________________________________________________
RELATIONSHIP:
________________________________________
NAME #2
_______________________________________________ PHONE (_____)
______-________
ADDRESS
_______________________________________________________________________________
RELATIONSHIP:
________________________________________
HOME CHURCH _______________________________________________________________________
Comments: ____________________________________________________________________________
______________________________________________________________________________________
We believe: STATEMENT OF FAITH
The Bible is the inspired, infallible, authoritative Word of God. There is one God, existent in three persons: Father, the Son and Holy Spirit.
In the Deity of our Lord Jesus Christ, in His virgin birth, His sinless life, His miracles, His vicarious and atoning death, His bodily resurrection, His ascension, His personal future return to gather together a triumphant Church that has been displaying the manifold wisdom of God.
The only means of being cleansed from sin is through faith in the shed blood of Jesus Christ and that regeneration by the Holy Spirit is absolutely essential for personal salvation.
That God provides healing in body, mind and spirit to the believer through the atoning work of Jesus’ shed blood.
In the Spirit-filled life by whose indwelling the Christian is given the power to live a victorious and effective life.
In the resurrection of both the saved and the lost, one to everlasting life and the other to eternal separation from God.
In the spiritual unity of believers in our Lord Jesus Christ.
I agree with the Statement of Faith I disagree with the Statement of Faith
SIGNED ________________________________________________ DATE ________/________/________
Note:
Please
be sure to carry three additional passport size photos and a copy of your passport.
© 2007 Warm
Blankets Orphan Care International