VIM Team Member Application | Mccurdy Ministries

Adult Individual Application

Adults volunteering in Volunteer in Mission (VIM) teams need to fill out the forms below to register. This is to be filled out by each team participant. The Team Leader will receive a copy, which should be kept in their possession throughout the trip. The Team Leader should also leave a copy of this form with their church in the event of an emergency.

APPLICANT INFORMATION

First and Middle Name

Team Service Start Date

Birthday

Phone

Languages

Last Name

Team Service End Date

Age

Gender

Work Phone

Occupation

Dietary Restrictions

Hobbies and interests:

Missions experience and location:

Church Name

Pastor

Why do you wish to participate?

Please indicate your state of physical and emotional health (the project and trip will include rigorous activity). Is there anything the team leader(s) should know regarding your health (allergies, diet, etc.)?

EMERGENCY CONTACT INFORMATION

Primary contact in case of emergency:

Name of Emergency Contact

Relationship to team member

Emergency Contact Address

Emergency Contact Cell Phone

Emergency Contact Work Phone

Emergency Contact Home Phone

Emergency Contact Email

OTHER INFORMATION YOU WISH TO ADD IF AN EMERGENCY ARISES:

Secondary contact in case of emergency:

Name of 2nd Emergency Contact

Relationship to team member

Address of 2nd Emergency Contact

Cell Phone of 2nd Emergency Contact

Home Phone of 2nd Emergency Contact

Work Phone of 2nd Emergency Contact

Email of 2nd Emergency Contact

Thank you. Please know that we are holding you in our prayers for a very fruitful mission!

Thanks for submitting! Our staff will reach out to you shortly.