Kentucky Mission Trip Registration

Please fill out this form and click submit.

June 16 - June 22

Sign-Up Deadline: March 3

Name

Phone

This address will receive a confirmation email

Number of adults participating

Participating adult's names

Number of children participating

Participating children's names and ages

Which ministry do you want to participate in

Please select one option.

Construction - providing major and minor home repairs to residents Community - feed, visit, clothe, and serve those who are enduring hard times Children's - lead life-changing and enriching day camps

If your family is dividing into different ministries, please list each name & what ministry they are doing

Will you be riding the bus?

Please select one option.

Yes No

Do you hold a CDL license, and if so, would you be willing to drive?

Please select one option.

Yes No

TWO emergency contacts are required.

NAME - Contact #1

PHONE - Contact #1

NAME - Contact #2

PHONE - Contact #2

Cost: $150 per person with a $600 cap/family. A $50 deposit per person is due now ($200 cap/family), and the remaining balance is due by June 1. Deposits are non-refundable (exceptions made for emergencies only).

DEPOSIT

1 person ($50) 2 people ($100) 3 people ($150) 4 people (cap/family) ($200)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form and click submit.

Kentucky Mission Trip Registration

Description

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