OYO | Doing Something Beautiful For God

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We are extremely excited that you have decided to serve with us! Simply complete the information below in order to register. Once registration is complete, we will contact you with further information. (Please note - we do not accept online payments for the registration fee.)

All information will be kept strictly confidential.

Offline registration is also available. To do so, download the mail-in registration form.

Select Your Mission Trip(s)

Select the mission trip(s) you are registering for:		Philadelphia, PA (August 22 - 24, 2008) *$150 USD
		Los Angeles, CA (October 3 - 5, 2008) *$150 USD
		Spokane, WA (November 14 - 16, 2008) *$150 USD
		Jacksonville, FL (December 12 - 14, 2008) *$150 USD

I am applying as:

Personal Information

First Name	Birth Month	Birth Day	Birth Year
Last Name
E-mail Address
Verify E-mail Address
Gender

Last 4 Digits of Social Security # or Social Insurance #
Passport # (Only applicable to International Mission Trips)
T-Shirt Size

Contact Information

Street Address		Father's Full Name
Street Address 2		Father's Work Phone
City		Father's Cell Phone
State		Mother's Full Name
ZIP		Mother's Work Phone
Home Phone		Mother's Cell Phone
Cell Phone

Emergency Contact Name
Emergency Work Phone
Emergency Cell Phone

Parish Information

Parish Name		Pastor's Name
Parish City
Parish State

Medical and Other Information

Overall Health Condition
When was your last immunization for tetanus?

Allergies
List an allergies:
How do you manage the allergies, if any?
What limitations do your allergies normally cause?

Medical/Psychological Conditions
List any diagnosed medical and/or psychological conditions from which you suffer:		Explain any medication or therapy for the above-mentioned condition(s)


Major Illnesses
Please explain any major illnesses within the last five years

Physician & Insurance
Primary Physician
Physician Phone Number
Insurance Company
Insurance Policy Number

Miscellaneous Information
Have you ever been convicted of a felony?
Please explain the circumstances and issues surrounding any attempted suicide.
List any limitations, diet restrictions, or specific health problems you have which might impair your ability to serve.
List any use of alcohol, tobacco, or drugs