Full Name

Date of Birth

Your E-mail

Phone Number

Are you a Christian?  Yes No

If yes, date of salvation

Are you baptized in water?  Yes No

If yes, date of baptism

Home Church

How long have you attended?

Pastor's Name

Please give your pastor’s e-mail address or contact information
so that we can request a recommendation

Do you serve actively in your church?  Yes No

If yes, in what way?

How did you come to know Jesus as your Savior?

Do you drink alcohol?  Yes No

Do you smoke?  Yes No

Do you use curse words?  Yes No

Why are you interested in serving with CrossCulture Jesus?

What languages can you speak and how well?

Are you currently working?  Yes No

If yes, where?

Are you currently studying?  Yes No

If yes, what is your focus?

Physician's Name

Physician's Phone Number

Please list any medications you are currently taking

Name of person we should contact in the case of an emergency


Emergency Contact's Phone Number

Please list any limitations, allergies, or disabilities you have
that could keep you from participating in some activities

How long are you planning to serve with CrossCulture Jesus?

What are your suggested travel dates?

(Please do not make any plans until you hear from us confirming the receipt of all necessary documentation and approval of the same.)

I understand that my participation with CrossCulture Jesus is completely voluntary with no remuneration of any type. I will be responsible for my personal expenses at all times. I understand that my volunteer service in this ministry is solely to promote the vision of CCJ and not to promote my own agenda. I will participate in the programs that CCJ sponsors and submit to the appropriate authority at all times. I understand that during my term I am a representative not only of CCJ but also of Jesus Christ and I commit to abstain from smoking, alcohol, coarse language (cursing, harsh words, dirty jokes, etc.), and non-Christian music at all times. In an attempt to maintain a pure testimony, I will not participate in gossip, backbiting, jealous envies, or engage in a romantic relationship during my service. I will commit to regularly attending a local church to keep myself spiritually fed.

I understand that if I do not comply with the rules and regulations of CrossCulture Jesus or if I act in a way that is unseemly for a follower of Christ I run the risk of being sent home at my own expense.

I understand that my service with CrossCulture Jesus is completely voluntary and at my own risk. I will not hold CrossCulture Jesus responsible for any harm to my person or belongings that could occur during my service. Should I need medical or legal aid during my service I am willing to cover these costs at my own expense.

I accept the terms  Yes No