Four Corners Community Church / Outreach / Short Term Trips

To apply for our summer Costa Rica Mission Trip, please fill out the information below:

First Name

Last Name

If applying as a family, please list all additional family members traveling with you:

Full Name and birthdate

Your contact info:

Street Address

City

State

Zip Code

Email Address

Phone Number

Medical Information:

Do you or any of your family memebrs have any medical conditions that we should be aware of? (Allergies, etc)

Do you or any of your family members take any medications? (Please list below).

In case of an Emergancy, please contact:

Questions:

Briefly describe your relationship with Jesus.

Why do you (or your family) want to be part of this mission trip?

Have you (or your family members) traveled on other mission trips outside the US?

Do you have any fears or concerns about the trip?

Short Term Mission Trip Application