Team Application

I. General Information

Name

(As it appears on your PASSPORT)

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Phone (h)

Phone (w)

Cell

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email

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Passport No.

Answer N/A if waiting on Passport

Date Issued

Expiration Date

Passport Country of Issue

II. Medical Information

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Date of Birth

Place of Birth

Sex

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Blood Type

Answer N/A, if unknown

Height

Hair

Eyes

Please Specify any medical disorders or allergies including food or N/A

III. Contacts In Case Of Emergency

Contact 1

Name (1)

Cell Phone

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Address

Relationship

Email

Contact 2

Name (2)

Cell Phone

Contact 2

Address

Relationship

Email

IV. Vocational, Skills & Talents

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Profession

Specialty

Other Applicable Skills

Foreign Language Skills

Hobbies

Previous Mission Trips

V. Spiritual Information

If you are not currently attending church please put N/A in the required fields.

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Home Church

If you are not involved in a church put N/A

Pastor's Name

Address

Briefly, share how you came to know the Lord

We ask that every team member have at least two people pray for them while on mission. Please list two people that you will ask to pray for you.

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Name

Phone

Email

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Name

Phone

Email

VI. Mission Fields

I have looked at the CERT calendar and I am interested in CERT trip(s) to:

VII. Photo / Video Release

Check all boxes

I hereby grant CERT International permission to use photographs and videos taken of me during the CERT Mission trip.
I understand that said photos and videos will be used for the purpose of glorifying our Lord Jesus Christ and for the visualizations of CERT missions.
I exclude from this agreement any photos or videos of myself that might inadvertently reflect me in a bad posture or if shown out of context could misrepresent myself or CERT International.

Signature

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T-Shirt Colors

Not all colors available in all sizes. Please select 2 color choices.

Color choice #1

Color choice #2