Cyber Forms HOPE Humanity Outreach Partners Enterprises


*Bold fields are required*
Please give us your name as it appears on your passport for international missions, or on your driver's license for national mission trips.
*First Name*
*Last Name*
*Street*
Street
*City*
*State*
*Zip Code*
*Country*
*Home Telephone*
Cell Phone:
Work Phone
*T-shirt Size*
Passport number	International trips only
Passport Expiration Date
*Your date of birth*	month/day/year
Airport of Departure	i.e. the airport nearest your home and your preferred airport to travel in and out of. Please select whether you are male or female
Male
Female
Church/Organization Name
Church/Org Address	Enter your Church's/organization's address Please give us at least 2 emergency contact people.
*Emergency contact first name*
*Emergency contact last name*
*Emergency Contact street address*	Enter your emergency contact's street address
*Emergency contact telephone*
Emergency Contacts Additional Phone
Emergency Contact's email address
*2nd Emergency Contact's first name*
*2nd Emergency contact last name*
*2nd Emergency Contact Address*	Enter your2nd Emergency Contact Address
*2nd Emergency Contact Telephone*
2nd Emergency Contact Additional Phone
2nd Emergency Contact email
*Your Email:*
Additional info	additional information you want us to have in the event of an emergency
*Trip Destination*
*Date of Departure*
*Date of Return*	Please give us your medical information Please list any physical disabilities or health problems you have, and indicate whether you have special needs regarding sleeping accommodations, meals, etc. If you have no issues, please indicate by putting the word NONE in the medical info box below.
*medical info*	medical info 2. List all medications you take on a regular basis, with exact dosages, if you don not take any medications indicate this by putting the word NONE in the box below.
*medications*	medications and dosages 3.Do you have any allergies?
Yes
No	If yes, please list allergies and Medications if needed
Allergies and meds	Allergies and meds Does your medical insurance cover you outside of the United States (or your country if you are not from the United States)
Yes
No	If yes, what is the process for enacting your insurance in another country?
Process	Process for enacting insurance
Name of Insurance company
Insurance Telephone
Policy Number	Please read through our mission agreement I realize that the following commitment is crucial to the effectiveness, quality, and positive expression of our mission together. As a participating member of the Humanity Outreach Partners Enterprises team, I agree to: Develop and maintain a servant attitude toward the people our team serves, as well as, toward each team member. Support my team leader(s) and his/her decisions. Respect people’s view of faith including those I share space with and work with including the host’s view of religious faith, realizing that different people have different expressions of faith. Accept the service that is going on in the area where I am serving as well as the local approach to the mission, though it may differ from my own approach. 5. Abstain from all use of substances including use of alcohol, illegal drugs, inappropriate clothing, and profanity from the time of my departure until I return home. (If you are a tobacco user, this trip is a great excuse for you to give up the habit! However, if you are simply unable to refrain, our organization is empathetic, we ask that you keep your habit to yourself and that no one on the team, the host or the locals sees you smoke.) Refrain from negativism and complaining. Travel and outreach initiatives outside my organization/church/college/workplace, etc., may present unexpected and even undesired circumstances. However, sense of humor, my support and creativity will enhance the moment. Refrain from gossip. If it is not true, good, and positive, I will not say it. Remember that I am a servant of Jesus Christ called to be in ministry with the host team. I will serve as best I can so that both the spiritual purpose and the task of the mission will be accomplished. Remember that I am representing a faith based agency, which has established itself as a servant of Jesus Christ; together we are called to be in service with the host, community and team. I will serve as best I can so that both the spiritual purpose and the task of the mission will be accomplished. Lift up Jesus Christ with my thoughts, words, and actions.
*I have read the above agreement and accept these terms.*	Type in your name Please check the mission that you are registering for.