Forms for Breakout! Missions with SICM
Please read the Mission Rules before continuing.
General
Name:
*
Address 1:
Address 2:
Town/City:
County/State:
Country:
Postal Code:
Telephone Number:
E-mail:
*
Gender:
Male
Female
Age:
Marital Status:
Mission applied for:
*
Date:
Health
Special dietary needs?
Yes
No
If "Yes", please specify:
Do you take any prescribed medicines?
Yes
No
If "Yes", please specify:
Any other medical information:
Ability/Experience
Please indicate your level of experience of each type of work.
Street work (one to one):
None
Little
Some
Experienced
Door to door:
None
Little
Some
Experienced
Sketchboard:
None
Little
Some
Experienced
Children's ministry:
None
Little
Some
Experienced
Youth ministry:
None
Little
Some
Experienced
Preaching:
None
Little
Some
Experienced
Testimony/shortword:
None
Little
Some
Experienced
Any other experience:
Please note: A lack of experience will in no way be a disadvantage to joining the mission team. This section of the form just gives us an idea of the strengths of the team.
Church Details
Church name:
Denomination:
Church minister:
How long have you been saved?
Personal Testimony/Church Involvement/Etc.
*
Indicate information required.
Click here to download the form be filled out by whoever is recommending you.
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