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Home
Mission
Youth Ministries
2019
Partners
Contact Us
Home
Programs
Tiny Homes
Food Boxes
Youth Programs
Building Bridges
EVENTS
Summer Mission Trip 2026
Christmas Banquet 2025
An Evening to Remember
Food Boxes
Our Founders
The Mission
WV Stories
Photo Galleries
2014
2015
2016
2017
2018
2019
2020
2021
2022
2024
2025
Volunteer
Trips
Online Registration
Liability Waiver
Donate
ADULT APPLICATION
DIGITAL APPLICATION
Adult Application
Name
*
First Name
Last Name
Birth Date
*
MM
DD
YYYY
Age
*
Gender
*
Male
Female
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Personal Phone Number
Personal Email
Your Church/Group Name
Church/Group Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Group Leader
First Name
Last Name
Phone
(###)
###
####
Email
Service Area 1, 2 & 3
Construction Site
Kitchen
Kids Camp
Painting
Janitorial/Cleaning
T-Shirt Size
S
M
L
XXL
XXXL
Check all that apply
Allergies
Bee/Wasp Reaction
Dizziness or Fainting
Hay Fever
Penicillin Allergy
High Blood Pressure
Physical Disability
Respiratory Problems
Asthma
Diabetes
Epilepsy
Heart Trouble
Operation Within Last Year
Pregnant
Regular Medication
Other
Emergency Contact
First Name
Last Name
Relationship
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Insurance Company
*
Policy Number
Thank you, we’ve received your application!
PRINTABLE APPLICATION
YOUTH APPLICATION
DIGITAL APPLICATION
Youth Application
Name
*
First Name
Last Name
Birth Date
*
MM
DD
YYYY
Age
*
Gender
*
Male
Female
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Email
T-Shirt Size (Adult)
S
M
L
XL
XXL
XXXL
T-Shirt Size (Child)
S
M
L
XL
Your Church/Group
Group Leader
First Name
Last Name
Areas of Service
Check your top 3 options
Kids Camp
Construction
Kitchen
Janitorial/cleaning
Painting
Medical Information
Check All That Apply
Allergies/Bee/Was Reaction
Dizziness or Fainting
Hay Fever
Penicillin Allergy
High Blood Pressure
Epilepsy
Physical Disability
Respiratory Problems
Asthma
Diabetes
Heart Trouble
Operation Within Last Year
Regular Medication
Other
Additional Medical Information
If there is something you need considered that isn't on the list please detail it below.
Emergency Contact
First Name
Last Name
Relationship
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Your Insurance Company
*
Policy Number
*
Name Insurance is Under
*
Relationship to
*
Digital Signature (Legal Guardian)
*
Type Your Full Name
Digital Signature (Applicant)
*
Thank you, we’ve received your application!
PRINTABLE APPLICATION
131 Gene Drive, Pittsburgh, PA 15237
412.780.7523
EMAIL
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