My Story

Health Declaration

Please fill out the following form
in order to participate in our mission trip.

First Name

Last Name

Email

Date of Birth

Have you been hospitalized in the last 12 months? *

No

Yes

Are you suffering from a medical condition, illness, or injury that can impact your participation to the international mission trip? *

No

Yes

If you answered yes to any question, please elaborate

Initials

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Bringing hope to nations, leading from transformed lives to restored communities

Address: Po Box 2613

Loganville, GA 30052

Or : 4160 Logan Dr, # 2613

Loganville, GA 30052

Thanks for submitting!

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