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Project Homework applicationDate: Wednesday, May 09, 2018 - Thursday, May 31, 2018 Time: - APPLICATION FOR SUMMER MISSION “PROJECT HOMEWORK” WEAKLEY COUNTY BAPTIST ASSOCIATION 195 Hunt Street, Dresden, Tennessee 38225 (731) 364-9762 FAX NUMBER DATE OF MISSION WORK: July 8-13, 2018 PLACE OF MISSION WORK: Weakley County Tennessee NAME:______________________________________________ AGE:______________ BIRTHDATE: _________________SEX: M F (Must have completed 8th grade) SHIRT SIZE (Circle One): Small Medium Large XLarge XXLarge XXXLarge ADDRESS:_________________________________________________________________________ CITY: _________________________________________________ STATE: ________ ZIP CODE:___ HOME PHONE: __________________________________ CELL PHONE: _____________________ EMAIL: ____________________________________________________________________________ CHURCH MEMBERSHIP:_____________________________________________________________ EMERGENCY CONTACT: ____________________________________________________________ RELATIONSHIP TO VOLUNTEER:_____________________________________________________ ADDRESS: ________________________________________________________________________ CITY: _________________________________________________ STATE: ________ ZIP CODE:___ Have you participated in a previous associational mission trip? Yes No Please check the areas which you are interested in serving: o Construction o VBS o Other_____________________________ MEDICAL INSURANCE COMPANY:____________________________________________________ POLICY NUMBER:__________________________________________________________________ CURRENT MEDICATIONS:___________________________________________________________ ALLERGIES:_______________________________________________________________________ OTHER SPECIAL NOTES:____________________________________________________________ SIGNATURE OF VOLUNTEER: _______________________________________ DATE:__________ FOLLOWING TO BE COMPLETED BY VOLUNTEER’S PASTOR OR CHAIRMAN OF DEACONS We certify that the above named volunteer is a member in good standing of our church and that they are faithful in attendance and support of the church program and pastor. We recommend them to you as they endeavor to serve the Lord in missions. SIGNED:______________________________________________________ DATE:____________ The trip fee for 2018 is $75. To be considered a part of the mission team, this form and the trip fee must be returned to the WCBA office by May 31, 2018. |
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