Name* :
Age:
Speak Spanish:
Yes
No
Fluency:
Attending Spouse:
Age:
Speak Spanish:
Yes
No
Fluency:
Address:
City/State/Zip:
Preferred Phone:
Email Address* :
Church Name:
Registrant Occupation:
Medical Experience To What Degree:
Spouse Occupation:
Medical Experience To What Degree:
Other Attending Family Members:
Name:
Age:
D.O.B.:
Name:
Age:
D.O.B.:
Name:
Age:
D.O.B.:
Name:
Age:
D.O.B.:
Previous Rocky Point Experience
Yes
No
If Yes, number of years:
Special Requests: Please note below any special skills you feel might be helpful, need to be on a particular team, with a life group, friend, etc.
Can you supply a tool trailer?
Yes No
Can you pull a tool trailer?
Yes No
Travel & Camp Site Information
Day you will arrive?
Wed. Thurs. Fri. Sat.
Will you be driving?
Yes No
If yes, can you take other people?
Yes No How Many?
Do you need a ride?
Yes
No If Yes, how many?
($20.00 per person suggested donation to drive for fuel)
Will not be staying at Playa Bonita Campground
Tent (small): 2-4 people
Tent (large): 4-8 people
Pop-up Camper
RV (Size )
5th Wheel (Size )
Travel Trailer (Size )
Special Needs?
Each camp site will have a minimum of 6 people per site (including RVs)
AREAS OF SERVICE
Building
Please indicate below your construction experience:
Concrete:
Experience:
Framing:
Experience:
Stucco:
Experience:
Kitchen/Cooking
Please indicate below the area in which you are interested in serving:
Cooking:
Self
Spouse
Minor: Minor:
Food Prep:
Self
Spouse
Minor: Minor:
Serving:
Self
Spouse
Minor: Minor:
Camp Setup/Tear Down/Site Support
Self
Spouse
Interpreter Support
Self
Spouse
Prayer Support
Will you commit to praying for us while we
prepare to go and during the trip?
Emergency Contact
Name: Phone:
Attendee Fees
After submitting this registration form, you will be given a link to the registration payment page. Contact Ron Andler (571-9716) for special payment schedules, situations or scholarships.
• $100.00 Per person
• $50.00 Per child under 7 years
Non-Attendee Sponsorship
I want to support the mission trip with the following tax-deductible donation:
- $25.00
- $50.00
- $100.00
- other
(Please indicate amount on the payment page.)
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