St. Joan of Arc Parish Mission Trip

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1 ADULT Application Packet St. Joan of Arc Parish Mission Trip Belize: July 9-15, 2016 Application/Initial Registration Form & Deposit Due by December 20, 2015 Adults and high school teens (current school year) are welcome to apply to participate in a mission trip to Belize. While you prayerfully consider participating in this trip, please keep in mind what the trip is all about. It is not a vacation (but do appreciate the beautiful country we will visit!) and it is not a specifically a service trip (although we will be serving others). This trip will be about solidarity within our global community, partnership, mutual sharing of gifts and accountability. Because we view this experience as part of a process involving reflection and action, we see your application as a commitment. Thank you for your interest and commitment to building solidarity with the people of Belize. Full Name: Gender: Female Male Age: Occupation: Full Address: Address: Participant Cell phone: Home phone: Spanish ability (none required): Fluent Good Fair Minimal None *English & Spanish is spoken in Belize* Do you have any specific dietary needs (i.e. food allergies, vegetarian, vegan, etc.?) This trip will involve sleeping on an air mattress, enduring hot and humid weather, may require walking long distances and may involve less than desirable (but safe) lodging accommodations. Do you think this will present any problems for you? If so, please explain: 1

2 Generally rooming is divided between men and women. Are you traveling with a spouse or other family member? Name of family member: Relationship to you: Participants over 18 years of age are required by the Diocese of Cleveland to complete the Virtus Workshop: Projecting God s Children (3 hour workshop) and be fingerprinted, due to interacting with minors on the trip. If you are over 18, have you completed these requirements? YES (Include year) : NO: N/A: Do you have any other needs or specific concerns about which we should be informed? PLEASE DO NOT WITHHOLD INFORMATION THAT CAN COMPRIMISE THE HEALTH OR WELLNESS OF THE PARTICIPANT AND/OR THE GROUP. Have you ever lived in or visited Latin America? If so, please briefly describe your experience, including the countries and dates: Why do you wish to participate in this mission trip to Belize? What do you understand to be the purpose of the trip? What do you hope to experience and learn? What fears or anxieties do you have about this trip? What interests/skills/background do you bring which will enrich the experience for yourself and for the group? Our group will be paired up with a local church in Belize. What ministries are you interested in and/or have gifts and talents. SEE ATTACHMENT C at the end of this packet for a list. 2

3 Please list any volunteer, ministry or mission trip experiences you have had: The cost of the trip will be $1,550. An $500 deposit is required upon registration and is due December 20, The balance, minus funds raised, will be due on June 1, If you are unable to pay the full deposit amount up front, please discuss this with Melissa as soon as possible to make arrangements. Each participant is responsible for the entire cost of the trip but has the option to participate in fundraising to reduce the cost. As a group, we will plan multiple fundraisers to raise as much money as possible to reduce the cost. The monies raised from each fundraiser will be divided among all mission trip participants who help with each individual fundraiser. For example, if you choose to participate in a bake sale you will get an equal cut to be applied to your total trip cost. If you choose not to participate in a bake sale, then you do not get a portion of the proceeds from that event. Basically you can choose how much or little fundraising you want to participate in. Inviting family and friends to help with each fundraiser is recommended. The more help we have the more money we can raise. Other ways to individually raise funds will be discussed and recommended, such as sending support letters to family and friends to sponsor you. Grants/scholarships may be available for those who wish to participate but need extra financial assistance beyond fundraising. Please indicate your preference regarding trip cost and fundraising: YES, I plan/need to participate in fundraising. NO, I do not plan to participate in fundraising. YES, I am interested in grants/scholarships beyond fundraising. 3

4 St. Joan of Arc Mission Trip Registration & Participant Agreement Belize: July 9-15, 2016 I, (adult participant ) understand that I am responsible for the cost of the trip, $1550. I understand that I can choose to participate in fundraising to reduce the cost. If there is a need to cancel, I understand that a full refund may not be possible. Enclosed with this application is a deposit of $500 (Due December 20, 2015). I understand that the balance, minus funds raised, will be due on June 1, I, (adult participant ), have read Attachment B which is a pre-view of the agreements included in official Praying Pelican Missions (PPM) online registration and agree to its terms & conditions. Participant Name Participant Signature Date 4

5 Participant (Adult or Teen) Medical Information (Exhibit A) Participant s Full Name: Date of birth: Emergency Contact #1: Name of Emergency Contact: Contact s relationship to participant: Phone # s for contact: Home # ( ) Work # ( ) Cell # ( ) Other # ( ) Emergency Contact #2: Name of Emergency Contact: Contact s relationship to participant: Phone # s for contact: Home # ( ) Work # ( ) Cell # ( ) Other # ( ) Medical Information: Chronic Illnesses: Allergies, including food allergies: Current Medications: Date of last Tetanus Immunization: Other: Name of Doctor/Primary Care Physician: Phone #: Insurance Information: Health Insurance Co: Member Number: Group Name: Group Number: 5

6 SJA Mission Trip ADULT PARTICIPANT FORM Authorization for Release of Liability & Responsibility I,, an adult 1) REQUEST that I be permitted to participate in the St. Joan of Arc Parish Mission Trip to Belize on July 9-15, ) UNDERSTAND that I WILL TRAVEL TO AND FROM Cleveland to Belize and any stops between (not mentioned), by airplane, motorcoach, rail, boat, etc., from July 9, 2016 through July 15, 2016 to participate in the St. Joan of Arc Parish Mission Trip, which may include side-trips. I further understand that the mission trip will go to the Orange Walk District of Belize and that the Praying Pelicans Missions will match the St. Joan of Arc Parish Mission Trip Team with an appropriate parish or mission in the above named district, and that this decision may be made shortly before the date of departure and too late for inclusion of this information in this form. I further understand the possibility of unforeseen hazards and inherent possibility of risk. I understand the risks involved and that there may be risk of injury due to travel, especially air and water travel. I recognize the possibility of injury and otherwise associated with travel in a foreign country, possible civil unrest, and in being in crowded conditions. I attest that I am in good medical condition, that I have no medical conditions that would restrict traveling as described above, that I have had a physical examination prior to travel and has received any shots or medications that may be required for going to Belize; I attest that I have listed any pertinent medical conditions on the medical authorization form attached hereto. I understand that it is my sole responsibility to provide adequate health insurance and I understand that standard medical insurance might not always cover medical treatment required abroad. I attest that I have adequate health insurance coverage. I also understand that the mission trip will involve a significant amount of walking and may involve physical labor and that side trips or recreation could involve swimming, snorkeling and traveling on water by a boat or water taxi to Caye Caulker Island or some similar location. IN CONSIDERATION of my right to attend and participate in this mission trip as described above, I hereby: AGREE to abide by ALL RULES AND REGULATIONS established by the St. Joan of Arc Parish Mission Trip Team, the Praying Pelican Missions, including those contained in the forms that I signed and the directions given by chaperones, designated volunteers and civil authorities in the countries visited. AGREES to release LIABILITIES, RESPONSIBILITIES AND INDEMNIFY AND HOLD HARMLESS, St. Joan of Arc Parish in Chagrin Falls, its pastor, the St. Joan of Arc Parish Mission Trip Team, the Roman Catholic Diocese of Cleveland, the Most Reverend Richard G. Lennon, as well as their respective employees, agents, representatives, sponsors and volunteers from and against all claims, judgments, liability (of any nature or extent), damages, causes of action, or injuries which in any way arise out of or relate to my participation in the above described mission trip, whether foreseen or unforeseen. Signature: Date: Printed Name: 6

7 SJA Mission Trip ADULT PARTICIPANT FORM Consent and Release of Liability for use of Participant s Likeness & Other Information (aka Photo Release) In consideration of being permitted to participate in the St. Joan of Arc Parish Mission Trip to Belize, I hereby grant consent for St. Joan of Arc Parish in Chagrin Falls, Ohio ( Parish ), and/or its agents to record (in writing or otherwise), photograph, audiotape, or videotape my image, likeness, and/or spoken words, in any form, and to display, release, exhibit, publish, or distribute the same, or any part thereof, for the purpose of and in connection with any material that may be created by or on behalf of the Parish including, without limitation, Parish bulletin boards; the Parish s website; print and electronic media; social media; Parish and marketing, public relations and communications materials and/or presentations and such other uses as may not be contemplated herein, without further notice or compensation as follows: I consent to all of the above. I consent to all of the above, except. I consent to only the following:. I do not consent to any of the above. I further understand that by entering into this informed consent and release, and by granting permission as stated herein, I hereby release the Parish, the Diocese of Cleveland, and their respective officers, including the Pastor of St. Joan of Arc Parish, directors, agents and/or employees from and against any and all liability, loss, damage, costs, claims, and/or causes of action arising out of or related to the above items to which I have consented. I further understand that the Parish and its respective officers, directors, agents and/or employees have no control over use of photographs, videotapes, audiotapes, or other records made by others and/or outside the scope of this consent and release. Finally, in signing below I acknowledge that all recordings, audiotape, videotape, photographic proofs, photographic negatives, positives and prints shall constitute the property of the Parish. Signature: Date: Printed Name: Residing at: 7

8 Attachment B The following agreements will be required of each participant during the Praying Pelican Missions online registration. The purpose of this printed text is to make you aware of the terms & conditions that will be asked of you on the official PPM Online Registration, which is different that this SJA Application. Text Below is copied directly from Praying Pelican Missions Online Registration. Media Agreement I give permission to Praying Pelican Missions to use pictures and videos taken of me or my child within promotional materials (brochures, pamphlets, postcards, website, etc.) in order to promote future missions trips. Policy Agreement I agree to follow the outlined policies as a mission trip member in accordance with Praying Pelican Missions (PPM): 1. As a representative of Jesus Christ, North America, and PPM, I will behave at all times in a manner that brings glory and honor to these institutions. 2. 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. 3. 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. I will do everything I can ahead of time to prepare myself for a "trip of a lifetime". 4. I am 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. If I am offered food, I will take it with a "thank you" and a smile. 5. 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. 6. I will respect and follow the PPM Trip Leaders and Group Leader and his/her decisions. 7. 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 put my best foot forward and be a witness in this activity and in everything I will participate in while on the trip. 8. 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 dissension and take focus away from the goals of the trip. 8

9 9. 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 "roll with the punches" and look at challenges as opportunities to be a witness for Jesus Christ. 10. 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. Rooms will usually have four people per room and shared beds. 11. 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. 12. I will not talk negatively about North American politics or the host country's politics during the trip. 13. I will abstain from using, consuming, purchasing, or possessing alcohol, tobacco products, and illegal drugs while on the trip. 14. I will not steal or commit any crime or do anything illegal while on the trip. 15. I will meet all medical, logistical, and legal travel requirements. 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 North America that is banned. 16. I will follow the travel, supply, clothing, financial, medical guidelines, etc. set forth and explained to me prior to the trip. I am responsible for knowing and following everything in the PPM handbook and explained at the group meetings. 17. If in the future I desire to return to the host country on a mission trip to visit any connections or ministry locations from this mission trip, I must do so through PPM or receive their written permission to do so. This will enable the overall vision for the ministry as agreed upon through PPM connections in the host country to continue. 18. If I break any of the rules listed above, at the discretion of a PPM representative and in conjunction with my group leader, my mission 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. Liability 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 Praying Pelican Missions (PPM) 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 PPM, its representatives and affiliated entities, other related organizations, and all individuals involved with this missions trip. I hereby release all leaders and organizations involved with this mission trip from any and all legal liability, and I acknowledge that PPM shall have not responsibility or liability for same. I hereby waive all my rights to pursue legal action against PPM or any other individuals or organizations associated with PPM in connection with the mission trip arising from, or related to, any 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, and I acknowledge that PPM has no responsibility therefore. I specifically release PPM and its representatives from any claim of negligence in 9

10 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 PPM and other individuals and organizations involved. In the event that it should become necessary, whether in an emergency or otherwise, I authorize PPM 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 the Individual Registration Form. I assume the full responsibility for any and all medical bills and early evacuation/transportation costs incurred related to this missions trip. I have read and am in full agreement with this release and waiver and policy agreement, and fully understand that I am waiving 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 PPM and its agents to make medical decisions on my behalf and agree to read and abide by all PPM rules as outlined in the Policy Agreement. I hereby declare that I will, or give my child permission to, travel to Belize through PPM on July 18, 2015 and authorize the adults serving on behalf of PPM to act as my agents. Release By clicking SUBMIT FORM, I agree that I am legally responsible for and have read, understand, and agree to all the information previously listed on this liability form and that all of my personal and medical information is up to date. I also agree to the Policy Agreement that I have read here and that has been gone through in detail by my group leader at our team meeting. 10

11 Attachment C Ministry Opportunities Our parish group may choose 3-5 of the following ministry options for our trip. PPM will match us up with a local church that can benefit from a partnership with our gifts/talents/interests. They will let us know what ministry we will be doing so that we can prepare. Children s Ministry: Minister to young children through leading VBS, puppet shows, crafts, Bible stories, sports, skits, and interactive games. Service Ministry: Live out the gospel through your work on various projects including painting, roofing, concrete work, tiling, or whatever projects are needed in the community Church Ministry: Worship alongside a local church and participate by providing special music, sermons, or testimonies, or helping lead Sunday School. Sports Ministry: Use sports such as soccer, basketball, Frisbee, volleyball, or any large-group game as a platform for building relationships and sharing the gospel. Prayer Ministry: Bless communities through times of intercessory prayers during prayer walks or pray with local churches at prayer meetings. School Ministry: During the school year, your team could minister at local schools by leading devotions, tutoring students, observing classes, or participating in recess. Mercy Ministry: Be the hands and feet of Christ as you visit and minister to shut-ins and others who may have been forgotten in orphanages, hospitals, prisons, and senior centers. Evangelism Ministry: Assist the local church in outreach by handing out Bibles, doing street evangelism, visiting door-to door, or sharing the gospel. Youth Ministry: Connect directly with youth in the community by leading a youth rally, fellowship night, or worship. Adult Ministry: Lead parenting classes, Bible studies, or leadership training. As you minister to adults, you are ministering to entire families and communities. Medical and Dental Ministries: If your group has specialized medical or dental training, your skills are in much need in all of our ministry locations. Other Ministry: Have a unique ministry that God has blessed you and your team to be able to lead? Let us know, and we will incorporate it into your customized trip. 11

Belize 2016 Short-Mission Trip Application

Belize 2016 Short-Mission Trip Application Name: Address: City: Sate: Zip: Home Phone: ( ) Phone: ( ) Able to Receive Texts? Y/N E-mail: Place of Employment: How Long Have You Attended CrossPoint Church