2015 Mission Team Land Package Application

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1 2 Velina Drive Albany, NY Mission Team Land Package Application Name Home/Cell Phone: Work Phone: Address City State Zip (Circle One) Evangelism/ Medical/ Construction I am interested in: (Check One) February 16 th -24 Carrefour and Balix Haiti We will be doing construction, medical and dental clinics as well as evangelism. We will also be working with orphans in these impoverished communities. $950 in country cost (airfare not included) *** When booking your airfare please book your flight to Puerto Prince in the afternoon on the 16th of February and departing on the 24th of February at 3 pm from Puerto Prince. March 10 th - March 19 th La Paz Bolivia $950 in country cost + Visa $135 dollars for 5 year.airfare not included. *** Details to be announced. April 14 th - April 21 st Restoration Ranch, Dominican Republic. We will be doing construction, working with orphan children as well as evangelism. We will also be working with orphans in these impoverished communities. $950 in county cost (airfare not included) June 30 th July 7 th Santiago Dominican Republic. Ministry will consist of Puppets, Dance Team and Street Evangelism in Poor Impoverished villages $950 in county cost (airfare not included) July 12-July 21 Yamasa and Restoration Ranch and Bavaro Dominican Republic. We will be doing construction, medical and dental clinics as well as evangelism. We will also be working with orphans in these impoverished communities. $950 in county cost (airfare not included) August 4th- August 15 th Kampala, Uganda $2500 total (including air fare) Medical, construction, children camps and evangelism.

2 Occupation: Talents/Skills: Ministry Experience: Have you been on the mission field before? If so, where? Do you speak Spanish? How fluent are you? Please list any health issues you may have: Please ALL medications you currently take: Contact person in case of an emergency: Name: Relationship: Phone Number: On this sheet below, or on a separate sheet of paper, please share a brief testimony of how you came to know the Lord and why you would like to be part of this mission team. Office Use ONLY Final approval by Pastor Jim Jorgensen

3 Missions Applicant Pastor Evaluation Form The following individual has submitted an application to go on the mission field with Breath of Life Missions. We would appreciate if you would take a moment and complete this evaluation, and submit it to the address below. Team Member s Name: Is the applicant: Saved Yes No Baptized in water Yes No Baptized in the Holy Spirit Yes No A member of your church Yes No Attends regularly Yes No Please rate the following (circle one for each): Christian maturity Leadership qualities Submits to authority Servant hood Team Player Please state your personal spiritual evaluation of the applicant, whether or not you support the applicant going on the mission field, and include any other comments you think may be useful to the decision process. Church Name: Pastor s Name: (please print): Pastor s Signature Date:

4 Field Policy Field policies are enforced on every mission trip for your safety and benefit. The policies strictly enforced on the field are: Dating: Dating while on the field with a team member, or host country resident, is strictly prohibited. Due to the fact that you are in a foreign area and may feel uneasy about being away from home, you can develop very close relations with your fellow team members. The main objective to being on the mission field is not to find "Mr./Mrs. Right," but to proclaim the gospel of Jesus Christ. Gossip: Gossip is a sin and can never bring good to any situation and will not be tolerated. Murmuring: Will NOT be tolerated! Fault-finding: Do not slander, backbite, or criticize any member of your team. This will only bring strife to your team. Solo-Crusading: The Bible speaks of going two by two. No one is allowed to run off by his or her self or go un-escorted to any location while on the mission field. Medications: If you have prescribed medications that must be taken, please bring the correct amount on your trip, as there may not be a pharmacy available for a refill. Smoking Cigarettes and Drinking Alcohol The conscious of the Christian church in the Latin Culture is that if you are Christian, you don t drink or smoke. Country Rules that MAY NOT BE BROKEN 1. Make no promises on the field to give money to anyone. Check with the team leader first! He will check with the local Pastor. The Pastor will have insight in to the lives of his people and will instruct the team leader accordingly. We do not want the people to look at the rich Americans to provide their needs. We want the people to see their local church and the Lord as their provider. 2. Whatever we do distribute food, clothing, toys, etc. needs to be done with a purpose, plan, and a future. 3. Do not wear expensive or costume jewelry on the trip. This is for your safety. 4. Do not give your home address, phone number, address, or instant message name to ANYONE on the field. Use your church address. This is not an option; it is a rule!! Please respect this rule. It is in your best interest. If you form a relationship with a national or field missionary and wish to communicate with them, discuss it with Pastor Jim FIRST (if he is part of your trip) or with your team leader.

5 Terms and Conditions Land Package price includes meals, (regional cuisine) and modest accommodations. Transportation will be provided upon your scheduled arrival and within the confines of Breath of Life Missions schedule only. All travel arrangements, transfers, fees, taxes, deposits, rentals, accommodations, meals, land package costs and the like, are non-transferable and non-refundable. By signing this form you agree to hold harmless, forfeiting all claims and/or liabilities against Breath of Life Missions or its agents. Although care will be taken toward the goal of personal safety, you agree that you are traveling at your own risk, and any claims brought against Breath of Life Missions for any/every reason, will be considered satisfied, for the settlement sum of one U.S. dollar, without any further recourse. Breath of Life Missions is a non-profit organization and will make every effort toward the continuance of our longstanding tradition of honesty and integrity, as we have for the last twenty years. A list of Pastors and Churches who endorse Breath of Life Missions can be found in our Participating Churches brochure. Check out our Testimony page for comments from past mission team members. All Mission fees must be paid in full in U.S. dollars, 30 days prior to departure. Checklist: 1) Attach a non-refundable deposit of $ for each application, and send it to the address below. 2 Velina Drive Albany, NY ) Make all checks payable to Breath of Life Missions, and clearly mark the check Missions Team. 3) Obtaining a travel visa and/or tourist cards/tax to enter and depart the country if necessary, will be the sole responsibility of the applicant, payable in cash upon landing, (US $10.00 each) upon arrival and departure per person. 4) Brief testimony of how you came to know the Lord and why you would like to be part of this mission team. 5) I accept/consent to all of the terms and conditions set herein this document and also set forth by Breath of Life Missions. 6) I have read the Field Policy and agree to follow it. Applicant Signature: Date: Legal Guardians

6 Office Use Only Final approval by Pastor Jim Jorgensen

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