Trip for which you are applying:
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Dates of Trip:
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For Accommodations:
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Requested Roommate:
Name as it appears on passport:
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Name you prefer to be called:
Home Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Cell Phone
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(###)
###
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Email Address
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Home Church/City/Denomination
Date of Birth
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MM
DD
YYYY
Passport number:
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Passport Date of Expiration
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MM
DD
YYYY
Please describe your current or recent employment and/or volunteer activities.
Have you gone on short-term mission trips before? If so, to where? When? With whom?
Outreach Foundation mission/vision trips are designed to build support for and connection to God's work around the world. With that in mind, how might your participation in this trip impact you, and how might you engage your congregation (and/or Presbytery) upon your return?
Emergency Contact:
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Contact's relationship to you:
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Contact's cell phone:
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(###)
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Contact's email address:
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Do you have physical/emotional health issues Outreach should know about if you travel with us?
CONFIDENTIAL MEDICAL INFORMATION FOR OUTREACH USE ONLY
In case of a health emergency, please list prescription medications you are taking:
CONFIDENTIAL MEDICAL INFORMATION FOR OUTREACH USE ONLY
Do you snore heavily or are you a light sleeper? (You are likely to have a roommate, and this info helps us to make appropriate pairings.)
Do you have any dietary restrictions? If so, what will you need to do to provide for your needs?
Passport Options
Waiver of Liability and Emergency Authorization
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I am participating in an Outreach Foundation mission trip of my own free will and understand that I should not participate unless I am physically and medically able. In consideration of The Outreach Foundation allowing me to participate, I assume full and complete responsibility for any injury, accident or illness that may occur while I am traveling to or from my home city and during my travel with The Outreach Foundation.
I give any licensed, practicing physician or hospital full authority to provide emergency medical treatment for me in the event such treatment is needed or necessary and I am not able to make such a decision. I also hereby give my permission for a licensed, practicing physician to administer whatever medical treatment he/she may deem necessary for me in the event of any medical emergency affecting me.
I understand that any expenses that are incurred by me due to accident or illness are my responsibility and not the responsibility of The Outreach Foundation. I also am aware of and assume all risks associated with participating in this mission trip. I, for myself and my heirs and executors, hereby waive, release and forever discharge The Outreach Foundation, its trustees and staff, its agents, representatives, successors and assigns, and all other persons associated with the mission trip, for any and all liabilities, claims, actions, damages, costs and/or expenses that I may have against them arising out of or in any way connected with my participation in this mission trip. I understand that this waiver includes any claims, whether caused by negligence, the action or inaction of any of the above parties, or otherwise.
Waiver of Liability and Emergency Authorization Signature
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First Name
Last Name
Payment Acknowledgement
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The trip costs may be paid online at https://www.theoutreachfoundation.org/online-giving. We ask that if you pay online and are able, please check the box to cover the credit card fees so that the full amount can go to the trip. You can check the box for “other” and type in that it’s for the trip.
You may also pay by check mailed to The Outreach Foundation, 381 Riverside Drive, Suite 465, Franklin, TN 37064.
The $150 trip deposit per person is due now.
One half of the remaining trip expense will be due 60 days from the start date of the trip with the balance due 30 days from the start date of the trip. We will contact regarding amounts and specific deadlines for payments and to confirm receipt of your application.
Thank you for traveling with The Outreach Foundation and helping us fuel the global mission of Christ by building trusted relationships.
If you did not upload a copy of your passport, please send that ASAP to Carol Dublin at carol@theoutreachfoundation.org
If you would like to make your $150 deposit payment online, click the link below. You can check the box for “other” and type in the trip you are applying for. Pay online here.
