Medical Outreach Application

 Male Female


Have you ever been convicted of any crime other than a minor traffic violation? If yes, please explain:

What part does Jesus Christ play in your life today?:

Do you have any previous missions experience? If yes, where & when? Medical Trip?:

I have checked my calendar and agree to attend the pre-trip meeting dates:

I agree to put forth my best effort to raise support for this trip
even if I choose to contribute the entire per person cost:

List any health conditions and allergies (including foods) that the team leaders should be aware of:

I take the following medications/prescriptions:


The information I have given is correct and may be verified by ACM if necessary. I understand that if I intern with ACM, ACM reserves the right to disqualify me from the internship for any reason it deems appropriate. I hereby release and hold ACM harmless from all claims arising under this application. I further understand that a criminal record check may be conducted on me and I consent to any such check.

 I agree to the terms and conditions

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Isaiah’s passing.

Dear Friends,
We have some very sad news to report.

We received word late Wednesday evening (7/19/17) that our dear friend Isaiah passed away suddenly. Apparently, he collapsed after dinner and they rushed him to the clinic, but he did not regain consciousness. We are keeping in constant contact with Mercy. The best thing we can do right now is to pray for Mercy, the kids, each other and the wide net of friends that Isaiah touched throughout a life well-lived.

We can also praise our amazing God, who can take a young, willing, one-eyed shepherd from Ingwavuma and create a wonderful life of impact and joy that spans continents and forever changes thousands of lives for the better.

In Him,
Bill Hazelton
President, ACM US Board