Backyard Mission Participant Application This form is to be filled out by mission trip participants who are coming as part of an already registered group. Each person in the group is required to fill out this form at least 30 days before your trip. If you are an individual or family looking at coming on a mission trip and do not have a team to come with, please note that where it says "Group Name" and "Group Leader". This Application Form is an integrated agreement that consists of the fields set forth below, the attached Liability Waiver. If you are having any difficulties filling out this form, please notify your team leader or local short term mission coordinator.Outreach Location*ChooseSydneyOtherGroup InformationYour Group's Name*Please write "individual" or "family" if you are not coming with an established group.Are you the Team Leader?ChooseYesNoWhat is the Size of your Group?What is your group leader's name?Mission Trip DatesFrom* To* General InformationFull Name*(As it appears on passport.) Preferred First Name or Nickname* Age*Birthday*Gender*MaleFemaleMarital Status*SingleMarriedSeparatedDivorcedWidowedYear of H.S. Completion*Current Occupation/Profession*Permanent Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone Number*(xx)xxxx-xxxxType*---HomeWorkMobileAlternate Phone Number(xx)xxxx-xxxxE-mail Address* Church InformationDo you regularly attend a local Christian church?*YesNoWhy not?*What's the name of your church?*Church Denomination*(if applicable)Senior/Missions/Youth Pastor's NamePastor's E-mail Address We ask for your pastor's contact information in order to try and send an encouraging update concerning your group while you are on the field.Have you committed your life to Jesus Christ?*YesNoPlease write a paragraph explaining how you came to know the Lord and describing your present relationship with Him:*Have you ever been on a Christian mission trip before or do you have any missionary experience? Please describe below:*Are you currently engaged in any ongoing behaviors that are contrary to biblical teaching?*YesNoIf Yes, please describe below:*Do you agree with GFM's Statement of Faith?*Statement of FaithYesNoTell us why you want to go on this mission trip and include any additional comments we need to know about you:Passport InformationALL Australian and N.Z. citizens MUST have a passport to travel on any of our international trips (you can ignore these fields for our domestic locations)Passport NumberPassport Expiration Date Country passport is fromWho can we contact in the event of an emergencyEmergency Contact's First and Last Name* Relationship to you*Contact Phone #*(xx)xxxx-xxxxType---HomeWorkMobileAlternate Phone #(xx)xxxx-xxxxType---HomeWorkMobileContact E-mail Address Alternate Emergency ContactAlternate Emergency Contact's First and Last Name Relationship to youContact Phone #(xx)xxxx-xxxxType---HomeWorkMobileAlternate Phone #(xxx)xxx-xxxxType---HomeWorkMobileContact E-mail Address Participant's Medical Insurance InformationDo you have Medical Insurance?*YesNoInsurance CompanyGroup NumberPolicy NumberIn whose name is the insurance?Participant's Medical InformationPlease be accurate and specific!Name of Family Doctor City and State/ProvinceDoctor's Phone Number(xx)xxxx-xxxxHospital and medical records for this participant are located at:Height*(feet)Weight*(pounds)Blood Type(if known)Please list all prescription medications you are bringing on the trip:MedicationDosage Please describe any allergies you have to medications:Please describe any other allergies/intolerences you have (food, gluten, etc.):Note: GFM will work hard to accomodate any food allergies listed in this box. If you do not list a food allergy here and tell us once you arrive, you may be required to purchase your own food.Date of last tetanus shot: Please describe any current or pre-existing health problems/medical conditions (i.e. migraines, asthma, chest pains, seizures, etc.):Please describe any physical activity limitations you have:Additional Comments :SignaturesThe following MUST be completed and signed by either the participant or a parent/legal guardian of the participant if participant is under the age of 18 years old: By signing below, I affirm that I am the participant named above and am at least 18 years old, or that I am the natural parent or legal guardian of the participant named above and that I give permission for the participant to attend and participate in the Global Frontier Missions function specified above. I further affirm that the above information is true, accurate, and complete to the best of my knowledge, and I affirm that I have read and agree with the Waiver of Liability and Consent Form. By signing below, I affirm that the above information is true and accurate to the best of my knowledge. I have read and agree to abide by the Global Frontier Missions' Code of Conduct. I understand that if I violate this Code of Conduct I will subject to a range of consequences, up to and including being prohibited from participating in any activities or programs of the organisation.Your Full Name Relationship to Participant(if participant is under 18) Electronic Signature (Your Full Name)*Date* I would like to receive follow up emails for further teaching after my trip with GFMAs part of our comprehensive training experience, we will send 5 emails over 30 days. These will help you remember the teachings you received and implement them in your life. You may unsubscribe at any time. Yes PhoneThis field is for validation purposes and should be left unchanged.