Belize 2016 Short-Mission Trip Application

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1 Belize 2016 Short-Mission Trip Application Name: Address: City: Sate: Zip: Home Phone: ( ) Phone: ( ) Able to Receive Texts? Y/N Place of Employment: How Long Have You Attended CrossPoint Church (or youth group)? Contact in case of emergency Name: Phone Number: Please take some time to answer the questions on the next page. These are for your benefit as much as they are for the trip leaders benefit. Answer the questions honestly. Don t feel like you need to sound super spiritual. Being real is what is most important. The last two questions are important so take some time to answer them well. Writing out the gospel and your faith story is valuable because it helps you really grasp the gospel and its impact in your life. Plus, it will really help you to be able to confidently share it with others.

2 1. Why do you want to be a part of this mission trip and team? 2. What questions, concerns, or fears do you have about going to Belize? 3. What consistent habits are you integrating into your life right now to help you grow spiritually? (i.e. Bible study, devotions, prayer, journaling, meeting with an accountability partner, gathering for worship, witnessing to friends, meditation on Scripture, fasting, reading spiritually challenging books, etc.) How would you describe your relationship with God presently? 4. This is a mission trip, which means the goal is to share the message and power Jesus Christ with others. Please share your current level of desire and motivation to share the gospel with others. Are you presently praying for your unsaved friends/family and trying to bring up God with them? If so, how has been going? 5. Let s say you have a friend who has heard of Jesus but doesn t know the gospel. How would you briefly share with them the good news of Jesus? Type or write on a separate sheet of paper and include Bible verses to support what you would share.

3 6. Your personal story of how Jesus Christ has saved you and changed your life is something we want you to be able to share with others on this trip. Please share your story, (write it as if you were sharing it with someone over a cup of coffee). Aim to be able to share your faith story within 3-5 minutes. (Please type out your answer to this question. You ll want it typed for later when we have you work on it as part of the mission trip preparation.) Mission Trip Commitment Belize Short-Term Mission Trip 2016 I understand that by joining the CrossPoint mission team to Belize from June 16-25, 2016 I will be representing CrossPoint Church and, more importantly, Jesus Christ during this trip. Therefore I am committing myself to a lifestyle that honors Christ in all aspects now and on this trip. I understand that this mission trip will involve a preparation process for ministry and evangelism. I will commit myself to attending mission team meetings and fulfilling my responsibilities for team ministry preparation. I also understand that once I turn in my deposit for this trip that I am committing to go on this trip and assume full responsibility for the financial costs for me to participate, which will be roughly $2,000 (dependent on sleeping arrangements and airfare). If at some point you decide not to go on this trip or are unable to go on this trip, CrossPoint Church will issue a refund or release from financial obligation if we are able to do so. Many trip costs are upfront and nonrefundable or only partially refundable. You are responsible for those costs even if you do not attend the trip. I will allow the youth ministry leaders (youth) or World Outreach Team (adults) to make the final decision on whether or not I participate on this mission trip. Signature: Participants who are under 18 years of age must also have at least one parent or guardian signature on their commitment form: I have read over the short-term mission trip information and I understand the commitment my child must make to participate on this trip and the financial costs of approximately $2,000 they must personally raise to go. I will encourage and support them as they raise funds and prepare for the trip. Parent(s)/Guardian(s):

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5 INDIVIDUAL REGISTRATION FORM REGISTRATION PROCESS Please fill out this form and turn it in to your group leader. (Group Leader: Please send copies of all individual registration forms to Thirst Missions 2 months prior to departure) Please fill out all 6 sections of this registration form: A. Registration Information B. Policy Agreement and Signature C. Medical Information D. Medical and Liability Release E. Official Agreement and Signature F. Notarization Permission Form (If Necessary) A. REGISTRATION INFORMATION Dates of Trip: June 16-25, 2016 T-shirt size (adult sizes): S M L XL XXL (please check each box when completed) Name Permanent Address Last First (Legal) Middle Preferred Nickname Street, Box, or R.R. City State Zip Code Temporary Address Check here if you want us to use this address; otherwise we will use the permanent address above. Please include dates that you will be at the temporary address and give complete address. Telephone: Cell: ( ) Home ( ) Work ( ) Gender: Female Male Age Birthdate Citizen of Birthplace Country Country Occupation Company Title Description Home Church Complete Name of Church Senior Pastor s Name Church Phone Number Street, Box, or R.R. City State Zip Code

6 B. POLICY AGREEMENT As a representative of Jesus Christ, my home country, and Thirst Missions, I will behave at all times in a manner that brings glory and honor to these institutions. I will respect and follow the trip leaders and group leader and his/her decisions. I am aware that my every word and action is being watched during the entire mission trip experience. Therefore, I agree to act and talk in a manner that glorifies the name of Jesus Christ. I want everything I do or say to draw people to Jesus. I will be spiritually, physically, and mentally prepared for a mission trip that will stretch me and mold me in ways that I can only imagine. As a guest in the country I am visiting, I will respect and follow the traditions of the local people and nationals. For example: if the way I dress offends them, I will change. I have come to learn from the people I am visiting. I will not criticize the culture, efficiency, work habits, food, traditions, etc. with which I come in contact with. I have come not to judge, but to learn, and to share the person of Jesus through my words, actions, and deeds. I agree to have a servant attitude at all times. When I am doing a task or ministry I don t particularly care for, I will try my best and and be a witness in this activity. I will use words that encourage and build up my team members and the nationals at all times. This means I will refrain from gossip or words that bring dissention and take focus away from the goals of the trip. I will have a positive attitude at all times. Every trip has its challenges and unforeseen circumstances. People could get sick, items lost, and plans changed. I realize that there are times I will need to adjust my expectations and plans and look at challenges as opportunities to be a witness for Jesus Christ. I will work with all members of the team. I will refrain from pursuing romantic relationships during the trip. If my spouse or significant other is on the trip with me, I will make every effort to spend time with each person of the group and interact with all team members. I realize that sleeping accommodations most likely will not allow me to stay in the same room as my spouse. Men will be in rooms with men and women with women. For those groups who have chosen to stay in a hotel, rooms will have 3-4 people per room. I will attend all team meetings and fulfill the responsibilities I have agreed to before, during, and after the trip. If I am not able to attend a meeting I will be in contact with my group leader as to what I missed. I will abstain from using, consuming, or possessing alcohol, tobacco products, and illegal drugs while on the trip. I will not steal or commit illegal act while on the trip. I also will not talk negatively about my host countries politics or the host country s politics during the trip. If in the future I desire to return to Belize on a missions trip to visit any connections or ministry locations from this missions trip, I must do so through Thirst Missions or receive their written permission to do so. This will enable the overall vision and plans for the ministry as agreed upon through Thirst Missions connections in Belize to continue. I will follow the travel, supply, clothing, financial, and medical guidelines set forth and explained to me prior to the trip. I am responsible for knowing and following everything in the team handbook and explained at the team meetings. I will follow all import and export laws. I will not attempt to bring any item or good into the host country or back into my country that is banned. If I break any of the rules listed above, at the discretion of a Thirst Missions representative and in conjunction with my group leader, my missions trip can be terminated and I can be sent home at my own expense. I realize that to attend this trip and represent Jesus Christ on the mission field is a privilege and if I abuse that privilege this constitutes the right for my trip to end prematurely. Date: Signature (applicant signature)

7 C. MEDICAL INFORMATION (Please fill out the top part of this section to the best of your ability. Answers not required) Date of last Tetanus Shot Blood type Immunizations: MMR (Measles, Mumps, Rubella) Yes No Hepatitis A Yes No Typhoid Yes No Current Insurance Policy Insurance Company Company Address Phone (Area Code) Number Street or Box City State Zip Code Policy # Group # Please list any medical or first aid training you may have: Licensed medical personnel expecting to practice medicine overseas must attach photocopies of credentials. If you are presently being treated for an injury, sickness, are under a doctor s care, or have any mobility limitations, please explain: Please list any food allergies or dietary restrictions: Please list specific known allergies (medicine, environmental, insect, etc.):

8 D. MEDICAL and LIABILITY RELEASE Matthew 18:15-20 and 1 Corinthians 6:1-8 instruct us to live at peace and to resolve disputes in private or within the Christian Church. I realize that the limited charitable resources of Thirst Missions should not have to be dissipated on litigation. Therefore, I expressly waive my right to file a lawsuit in any civil court or other secular setting against Thirst Missions, its representatives and entities, other organizations, and all individuals involved with this missions trip. I hereby release all leaders and organizations involved with this missions trip from any and all legal liability. I hereby waive all my rights to any legal liability on the part of Thirst Missions or any other individuals or organizations involved, from which liability may result from sickness, injury, or death that may occur on or related to this trip. I fully realize that there are hazards, and I am fully assuming these risks, including but not limited to: hazardous traffic, poor roads, food, allergies, dangers resulting from military or political problems, storms or hurricanes, sickness, injury, and disease. I specifically release Thirst Missions and its representatives from any claim of negligence in their duties as leaders or otherwise on this missions trip. In the event that I attempt to make a claim in violation of my release and waiver as herein indicated, I hereby agree to, and shall pay, all legal fees and costs incurred by Thirst Missions and other individuals and organizations involved. I hereby acknowledge that Thirst Missions representatives will be taking pictures and videos throughout the trip. I agree by signing this form to allow my image to be used by solely by Thirst Missions in promoting future mission trips. I may decline to have my image included by sending an to or a written letter to Thirst Missions, stating that I decline to have my picture and video image included in future promotional materials. In the event that it should become necessary, whether in an emergency or otherwise, I authorize Thirst Missions and its adult individuals serving as its agents to arrange for any and all treatment including but not limited to: x-ray examinations, anesthesia, dental, medical, surgical, and/or treatment and/or hospital care for said participant on behalf of participant; and in such event, said participant agrees to pay for all costs, charges, fees, and expenses and travel and/or emergency expenses incurred as a result of treatment. The undersigned represents that the participant suffers from no disease or injury and has no other requirements for supervision, medication, or care other than those listed previously on this form. I assume the full responsibility for any and all medical bills and early evacuation/transportation costs incurred related to this missions trip that are not already covered or paid for. I have read and am in full agreement with this release and waiver and policy agreement, and fully understand that I am waivin g any rights I may have to litigate and sue. I accept full responsibility for visiting a doctor prior to the trip, all insurance, transportation to/from the host country, and all medical costs. I authorize Thirst Missions and its agents to make medical decisions on my behalf and agree to read and abide by all Thirst Missions rules as outlined in the Policy Agreement. E. OFFICIAL AGREEMENT AND REQUIRED SIGNATURE Date: Signature (applicant signature)

9 F. NOTARIZED LETTER OF PERMISSION TO TRAVEL ONLY FOR TRAVELERS UNDER 18 YEARS OF AGE AT THE DATE OF TRAVEL All travelers are required to turn this notarized letter of consent form in to their trip leader prior to the mission trip. Failure to do so will most likely result in being denied boarding of the intended flight or entry into the intended country. The original copy of this form must be provided at the airport or to an immigration agent upon request.. We, the undersigned, and (PRINT THE NAMES OF BOTH PARENTS OR LEGAL GUARDIANS) do hereby grant full permission for our son/daughter, (PRINT YOUR SON/DAUGHTER S NAME) whose birthday is _/ / (Month/Day/Year), permission to travel with on the dates of. PARENT SIGNATURES: If this consent form has only one of the parent s signatures, the traveler must also provide a notarized copy of the deceased parent s death certificate or a copy of divorce papers showing sole custody of the parent who signed the notarized parental consent form. SIGNATURE OF FATHER OR GUARDIAN: SIGNATURE OF MOTHER OR GUARDIAN: DATE: DATE: Address: STREET ADDRESS CITY STATE ZIP Phone Number: NOTARY PUBLIC SIGNATURE: Subscribed and Sworn to before me this day of 20 NOTARY S SIGNATURE (SEAL) Notary Public In and For the County Of: And the State of:

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