Legal Middle Name:

Preferred Name:

Birthdate: MM//DD//YYYY

Chronic medical conditions:
(Including Depression, Anxiety, and other Psychiatric History)

Allergies:
(Please include food and environmental allergies.)

Medications:

If so, what is your Passport number?

What is your passport expiration date:

Write your name EXACTLY as is on your passport. 

EMERGENCY CONTACT INFORMATION:

Relationship:

Name:

Cell Phone Number:

Email Address:

• As a member of this team, I am a disciple of Christ, presenting the Gospel. I will be asked to extend myself beyond my comfort zone to people who are different than me. By clicking SUBMIT, you are stating that you understand this and are willing to look at people as Christ did, not judging them, but loving them, and not looking upon any with racist eyes, but willingly accepting them as a part of God's creation.
• As a member of this team: I understand that I will be exposed to different cultures, foods, customs, and hospitalities. By clicking SUBMIT certifies that you agree, as a Christ-like servant, to abide by those customs and accept without complaining, the accommodations and food provided.
• As a member of this team: I understand that I will be representing Southern Wesleyan University as a guest in another culture. By clicking SUBMIT, you are stating that you understand that there may be specific expectation given by the organization or ministry you will be serving alongside of and will comply with those expectations.