Team Member Questionaire {required}

Mission Team Questionnaire (this must be returned with the Application and Medical Release forms)

Name:
Address:


Phone: (with area code)
Date of Birth: (under 18 need permission slip signed by parent or guardian)

Email address: (very important)




Do you have any health issues that we should be familiar with? (please give dates relevant to strokes, heart attacks, or other health issues that may be persistent or chronic) What, if any medications are you currently taking?


Do you have any allergies (food or otherwise)?
If yes, do you carry medication with you for this at all times? If no: what is that medication(s)?

If you have allergies, when was the last time (date) that you had an issue with this problem?

Do you know of any other health issues that we should know about for your protection and/or the safety of others?

Have you ever suffered from shortness of breath or other lung or breathing problems?

Do you have a preference of a roommate IF we should be able to arrange it?


Do you understand that you will need to drink only bottled water that will be provided there?

Do you understand that you will not have food choices and that you will need to be ready to eat whatever SCORE provides?


Do you know anything about Animistic Beliefs?


We must be culturally sensitive while NOT compromising the essentials of the Christian Faith. These areas may be remote and can be very dark spiritually. Will you commit to pray daily for these people and for your team – before, during and after the Mission here (beginning today)?

Accommodations may be like none you've experienced before. Please prepare yourself mentally and physically for this reality.

Your safety and health are one of our primary concerns. Will you promise to carefully adhere to these guidelines?

Signed:___________________________________________ Date: ____________________

Pastor Sign to show your approval of this applicant for this mission:___________________________ Date:____________