The Church at Brook Hills

Trip Information

• Application Date*
• Location of Trip*
• Dates of Trip*

Personal Information

• Full Name*
• Date of Birth*
• Email*
• Phone*
• Skype Name (If Applicable)
• Street Address*
• City*
• State*
• Zip Code*
• Occupation and Professional Skills
• Gender* [select] Male Female
• Marital Status* [select] Married Single
• If Married, Spouse's Name
• If Children, Children's Name(s)

Reference Information (Please give a Reference for the Global Disciple-Making Team to contact on your behalf)

• Name of Reference*
• Email*

Membership Information

• Check one of the following:*

  • Member of The Church at Brook Hills
  • Signed up for IMPACT
  • Not a Member of The Church at Brook Hills
• Are you regularly involved in a small group at The Church at Brook Hills?*

  • Yes
  • No
• Name of Small Group Leader
• How long have you been attending?

Please answer the following questions in the space provided in 100 words or less

• Write out the Gospel in your own words.*
• Write out your salvation story, including when you were baptized.*
• How are you currently growing in your relationship with Christ?*
• List all ministry involvement.*
• List any cross-cultural short-term or mid-term mission experience you have had.*
• How are you currently sharing your faith? Please give a recent example of sharing your faith.*

The information disclosed below will be read and held with confidentiality by members of the Global Disciple-Making Team and your Short-Term Team Leader. Answering yes to the following questions does not necessarily disqualify you from joining a Short-Term Team. However, in order to uphold the integrity of the individual, other team members and for the sake of the Church and gospel we ask that you carefully consider the questions below.

• Excluding minor traffic violations, have you ever been convicted of any violation of any law or ordinance?*

  • Yes
  • No
• Have you ever been arrested or criminally convicted for either physical or sexual abuse of a child? *

  • Yes
  • No
• Do you have any physical impairment that prevents you from physical work? *

  • Yes
  • No
• Have you been under the care of a counselor or licensed mental health professional over the last 12 months? *

  • Yes
  • No
• Do you have any medical issues that the Global Disciple-Making Team should be aware of? *

  • Yes
  • No
• Is there anything in your life that will bring reproach on you, your family, the church, or Christ? *

  • Yes
  • No
• *If yes to any of the previous questions, please clarify below

Financial Support Information

The Global Disciple-Making Team offers discounts to qualifying individuals going on a Short-Term team. These include the Team Leader, Students (those in Middle School, High School and College), families with two or more members going on the same trip and individuals in need of extra financial support.

• Please choose one of the following options:*

  • Option 1: I am a team leader of this trip
  • Option 2: I am in middle school or high school
  • Option 3: I am in college
  • Option 4: I am going on this trip with another family member
  • Option 5: I have earnestly attempted to raise money for this trip but have been unable to do so and would like to apply for the Hardship Scholarship
  • Option 6: I would not like to apply for any of the scholarships listed above.

Travel Insurance Information (The Church at Brook Hills may purchase traveler’s insurance on your behalf if applicable. Please list your beneficiary for this purpose below.)

• Name*
• Relationship*

Passport Information (If you do not have a passport or are applying for a passport, please enter APPLYING in the fields below)

• Name (as it appears on your passport)*
• Passport Number*
• Issue Date*
• Nationality*
• Place of Issue*
• Passport Expiration Date*

In submitting this application:

• I am expressing my agreement with The Church at Brook Hills’ Vision, Mission, Goal, Values, and Strategy, Statement of Beliefs, and Community Covenant.

• I am willing to work under the direction of the Global Disciple-Making Team and Field Partners to accept and to perform any and all assignments with a God-honoring attitude.

• I am willing to conform to the standards of the national Christians, even if those standards are stricter than my own.

• I agree to be subject to a background check.

• I am confirming that I have the time and energy to devote to the pre, mid, and post-trip responsibilities.

• I agree to participate in the training arranged by the Global Disciple-Making Team and complete all requirements for the trip.

• I agree to return home at my own expense if the Field Partner, in conjunction with the Global Disciple-Making Team, determines my behavior is/has been inappropriate and therefore jeopardizing the long-term ministry.

• I acknowledge that The Church at Brook Hills will not be responsible for extra trip expenses (i.e., airline, hotel, etc.). Should these occur, they will be passed along to the traveler.

• I understand that my involvement on this trip can be denied prior to travel if I do not participate in the full preparation of the trip.

• Name of Applicant*
• Date*

*Don't forget to download the Medical Release Form and Checklist before you submit the form.