Mission Trip Application & Questionnaire

Thank you for your interest in volunteering at Rehema Home! All applicants must fill complete our Mission Trip Application & Questionnaire. If you are 21 or under, you are considered a minor. You will need request a paper version so your parent or guardian can sign it and have it notarized. 


Please complete the form below

General Information
Name *
Sex *
Address *
Your Preferred Phone *
Your Preferred Phone
Do you have a valid passport? *
Birthdate *
Have you participated in any overseas travel experiences in the past? *
Country, Length of Trip, Reason for Trip (Missions, Business, Pleasure, etc.)
Health & Background Information
Have you ever been convicted of a misdemeanor or felony? *
Vision, Skills & Faith
Emergency Contact Information
Primary Emergency Contact *
Primary Emergency Contact
Secondary Emergency Contact *
Secondary Emergency Contact