Mission Short-Term Mission Trip Application - Jscrossroads.org

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Mission Short-Term Mission Trip Application - Jscrossroads.org Powered By Docstoc
					             P. O. Box 670, 1454 South State Route 44 Highway, Jersey Shore, PA 17740
                                570.398.5533 www.jscrossroads.org



        SHORT-TERM MISSION TRIP APPLICATION PACKAGE
CONTENTS:

1. MISSION TRIP APPLICATION
2. MISSIONS COVENANT AGREEMENT
3. AGREEMENT AND RELEASE FROM LIABILITY
4. CONSENT FOR MEDICAL TREATMENT
5. PERMISSION FOR A MINOR TO PARTICIPATE


    ALL CROSSROADS COMMUNITY CHURCH MISSION TRIP PARTICIPANTS
    MUST COMPLETE THIS APPLICATION AND RETURN IT TO THE CHURCH
     OFFICE AT LEAST 7 DAYS PRIOR TO THE MISSION DEPARTURE DATE

PLEASE RETURN THE APPLICATION PACKAGE TO ANY ONE OF THE FOLLOWING:

       Information Table at our Morning Worship Service
       Your Mission Trip Team Leader or Mission Team Leader
       Crossroads Community Church Office
        P. O. Box 670, Jersey Shore, PA 17740
        Fax: 570-923-7160




1                                    Crossroads Community Church Short-Term Mission Application
                     PLEASE MAKE SURE THAT YOU HAVE SIGNED WHERE APPLICABLE
                    OR IF A MINOR, YOU HAVE OBTAINED YOUR PARENT’S SIGNATURES

                                                       Date of Trip_____________________

                              MISSIONS TRIP APPLICATION

Trip destination:             ___________              Team Leader:          _______________

Preferred Name_______________________________________________________________________

Name (as it appears on your passport or photo I.D.):                   ____________________

Address:                                     _____________             ___________

City, State, ZIP:       ___________________

Home Phone:                   ______________           Cell Phone:           _______

Work Phone:                                 Email: ___________________________________________

Occupation:     ___________________________ Date of Birth:_________________________________

Parent/Guardian Contact Information

Name:           _____________                          Home Phone:           _______

Cell:   ______________                       Email:          ______________

Emergency Contact Information

Name:                   _____________                  Relationship:         ___________

Contact Phone Number(s):             ____________________

Current Medical Insurance is required for all participants

Insurance Provider:           _______                  Policy Number:        _____________

Physician’s Name:                    _______           Phone Number:         _____________




2                                       Crossroads Community Church Short-Term Mission Application
Questions

The following questions will provide the team leader with helpful information about you. We
encourage you to answer as many questions as possible.

    1. What is your present and past involvement with Crossroads Community Church? (If not a
       member of Crossroads Community Church, please indicate present affiliation with any other
       religious community).


    2. Why are you interested in participating in this mission trip?


    3. What do you expect to get from this experience?


    4. What are some of your gifts you feel you could benefit this trip?


    5. In what other, if any, short-term mission trips have you participated?


    6. Please list any previous experience that might be relevant to this trip:


    7. What are your skills or hobbies (such as photography, working with children, providing health
       care, construction, etc.) that might be useful on this trip or in the interpretation experience
       after the trip?


    8. General Health: __ Excellent     __ Good __ Fair

    9. Do you have allergies? __ Yes __ No (If yes, please explain)


    10. Dietary restrictions? __ Yes __ No (If yes, please explain)


    11. Do you have physical challenges? __ Yes __ No (If yes, please explain)


    12. What languages do you speak fluently?




3                                       Crossroads Community Church Short-Term Mission Application
                               MISSIONS COVENANT AGREEMENT

You must be willing to embrace and follow the attitudes and guidelines described in this mission
covenant agreement.

Realizing that the following guidelines are crucial to the effectiveness, quality, and safety of our trip, as
a member of the group, I AGREE TO:

    1. Respectively follow the decisions, directions and policies of those in leadership.

    2. Immerse myself in the local culture, as much as possible, and abstain from making derogatory
       comments about local cultures and congregations, or getting in arguments regarding people,
       politics, sports, religion, race, or traditions.

    3. Acknowledge that by engaging in this journey, I am subjecting myself to certain risks voluntarily,
       including but not limited to such things as health hazards due to poor food and water, diseases,
       pests, poor sanitation, potential injury while working and inadequate medical facilities.

    4. Affirm joyfully the standards of the local body of believers, even if their standards are stricter
       then my own, including areas of attire such as dress and shorts length, jeans, etc.

    5. Not use illegal drugs or alcohol during the mission trip. The use of tobacco may be restricted.

    6. Refrain from meddling, complaining, gossiping, criticizing, and using obscene or insensitive
       language or humor. I acknowledge that participating in a mission trip can present numerous
       unexpected and undesired circumstances. But, the rewards of conquering such circumstances
       are immense.

    7. Realize that sightseeing and shopping will be permitted only if it does not interfere with the
       team’s main purpose.

    8. Remember that I have come to serve. I may come across procedures that I think are inefficient
       or attitudes that I find close-minded. However, I will be PATIENT, and open to learning other
       people’s methods and ideas.

    9. Develop and maintain a respectful and cooperative attitude towards my teammates and others
       we encounter.

    10. Not leave my assigned area of ministry or separate myself from my assigned group without first
        obtaining permission from the team leader or the group leader.




4                                        Crossroads Community Church Short-Term Mission Application
    11. Abstain from any behavior or practice that is not conducive to the values of Crossroads
        Community Church.

    12. Not wear revealing tank tops, visible underwear, shorts with inappropriate length or clothing
        with inappropriate slogans.

    13. Respect my fellow participants’ right to their privacy, possessions and peace and quiet.

    14. Be as flexible and open-minded as possible.

    15. I commit to the mission trip and agree that I must participate fully in the entire trip from
        beginning to end.

    16. Raise funds for this trip by personal fund raising and personal contributions before requesting
        funds from the mission team.

    17. I understand that if I enroll and then choose NOT to participate in the mission trip, refunds may
        not be possible.


Participant Signature:                                      _______              Date:      _______



Parent/Guardian Signature:                                  ____       _______   Date:      _______
                                      (Required for participants under 18)




5                                        Crossroads Community Church Short-Term Mission Application
                      AGREEMENT AND RELEASE FROM LIABILITY

                                      Voluntary Participation
I, _____________________________, acknowledge that I have voluntarily applied to participate in a

short-term mission trip to ______________________________ with Crossroads Community Church.


                                      Assumption of Risk
I am aware that the mission trip may involve risks. I am voluntarily participating in the mission trip. I
hereby agree to accept any and all risks of injury or death that may result from my participation in the
mission trip.

                                      Release of Liability
As consideration for being permitted by Crossroads Community Church to participate in the mission
trip, as consideration for Crossroads Community Church assisting in arranging the mission trip, and for
other good and valuable consideration the receipt and sufficiency of which is hereby acknowledged, I
hereby irrevocably and unconditionally release, waive, discharge and covenant not to sue or attach the
property of Crossroads Community Church, or any of their affiliates, subsidiaries, divisions, members,
directors, officers, employees and agents (collectively referred to as the “Releasees”), for and from all
claims of any nature now or hereafter existing whether known or unknown, including but not limited
to all liability, on account of death, injury, or damage resulting from negligence or other acts, however
caused, of the Releasees as a result of my participation in the mission trip. I UNDERSTAND THAT I AM
GIVING UP MY LEGAL RIGHTS AND THE RIGHTS OF MY REPRESENTATIVES TO RECOVER FOR INJURY,
DEATH, OR PROPERTY DAMAGE.

                              Knowing and Voluntary Execution
I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE
THAT THIS IS A RELEASE OF LIABILITY AND CONTRACT BETWEEN ME ON THE ONE HAND, AND
CROSSROADS COMMUNITY CHURCH, AND/OR THEIR AFFILIATES ON THE OTHER HAND; NO ORAL
REPRESENTATIONS, STATEMENTS OR INDUCEMENTS APART FROM THIS AGREEMENT HAVE BEEN
MADE TO ME. I SIGN THIS AGREEMENT OF MY OWN FREE WILL.


Participant Signature: __________________________________ Date:___________________

Parent/Guardian Name: ________________________________
                                    (Please Print)




6                                         Crossroads Community Church Short-Term Mission Application
Parent/Guardian Signature: _____________________________ Date:___________________
                                   (Required for participants under 18)
                      ADULT CONSENT FOR MEDICAL TREATMENT

I, ____________________________ do hereby give my consent to participate in the Crossroads
Community Church mission trip to ______________________________. I am aware that by my
participating in this activity, there is a possibility that there may be a need for emergency medical
treatment as a result of an accident or sickness.

In the event emergency medical treatment becomes necessary, I grant _________________________
________________________, team leader for the mission trip to _____________________________,
or his/her assistants, authority to obtain emergency medical assistance.

I also consent to being transported from the premises by private car or other modes of transportation
for the purpose of the treatment.

I further give my permission for medical personnel to administer emergency medical treatment.

Participant Signature:_____________________________________ Date:________________________



                      MINOR CONSENT FOR MEDICAL TREATMENT
                           (Required for participants under 18 years of age)

We/I, the undersigned parents/guardians of _______________________________________________
                                                                          (Child’s name)
a minor, do hereby give our/my consent for ________________________________________________
                                                                          (Child’s name)
to participate in the Crossroads Community Church mission trip to _____________________________.
We/I are aware that by my child participating in this activity, there is a possibility that there may be a
need for emergency medical treatment as a result of an accident or sickness.

In the event emergency medical treatment becomes necessary for my child, we/I grant to
_________________________, team leader for the mission trip to ____________________________,
or his/her assistants, authority to obtain such emergency medical assistance.

We/I also consent to my child being transported from the premises by private car or other modes of
transportation for the purpose of treatment.

We/I further grant my permission for medical personnel to administer emergency medical treatment.

Names of Parent/Guardian: __________________________________________________________

Parent/Guardian Signature: ___________________________________ Date: __________________


7                                          Crossroads Community Church Short-Term Mission Application
                           PERMISSION FOR A MINOR TO PARTICIPATE


NOTE: This form is to be used for youth entering 7th – 12th grade that will be accompanied by a responsible
adult rather than a parent, grandparent or legal guardian. Children entering 1st – 6th grades must always be
accompanied by a parent, grandparent or legal guardian.




We/I _________________________________________________________hereby grant permission to
                              (Name of Parent(s)/Guardian-Please Print)

_____________________________________________________________, age _________ who is my
                             (Name of Minor-Please Print)

_______________________________________ to travel with a Crossroads Community Church Mission
         (Son, Daughter, Ward, etc.)


Team to ________________________________.


______________________________________ will be accompanied by __________________________
           (Name of Minor-Please Print)

_________________________________________________.
           (Adult’s name-Please Print)



Names of Parent(s)/Guardian ___________________________________________________________
                                                            (Please Print)

Parent/Guardian Signature: ______________________________________ Date: __________________


Parent/Guardian Signature: ______________________________________ Date: __________________


I consent to being responsible for the minor mission team participant from the time of departure until
the minor is returned to his/her parents or guardian.

Name of Adult Responsible: ___________________________________________________________
                                                              (Please Print)


Responsible Adult Signature: _____________________________________ Date: __________________




8                                               Crossroads Community Church Short-Term Mission Application

				
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