Statement of Faith
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Sponsorship & Gifts
Individual Mission Team Application
Parent/Guardian (If you are a minor)
Zip/ Postal Code
(valid email required)
If someone told you about Mission To Haiti, who was that person?
Which mission team would like to serve on?
January 28–February 4, 2019
March 28–31, 2019
May 11–18, 2019
June 8–15, 2019
July 13–20, 2019
Mission Team Interest 2019
Mission Team Interest 2020
***NOTE: 8 day teams cost $600***
If approved, will you be traveling with other team members to Haiti?
Yes - I will be traveling with a group
No - I will be traveling alone
I'm not sure - Please send me information about buying tickets
If you are traveling with a group, who is your group leader?
What training, skills or special talents do you have?
(Please tell us what your primary skills are and if you have any other abilities. )
What hobbies or personal interests do you have?
From the work teams we have, where do you feel you would like to serve?
(Your work team assignment will be made based on your skills, the work teams scheduled and where you are needed the most.)
Mobile Medical Clinics
Bible School for Children
Haiti Relief/Food Distribution
Wherever you need me
Do you speak a foreign language, and if so which one(s)?
Foreign Language(s) (If applicable)
Do you have any medical conditions that we should be made aware of?
If YES, please explain
In case of an emergency while in Haiti, who should we contact?
Emergency Contact Name
Which church do you attend?
Are you a member?
What do you do in your church?
For Example: teach Sunday School, sing in the choir, deacon ...
If needed, who can we contact as a reference for you?
Please provided us with any comments that will help us process your application.
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Small $15.00 USD
Medium $15.00 USD
Large $15.00 USD
Extra Large $15.00 USD