Rev. Dr. Paul Carrette Senior Pastor Church of Living Waters Dominica Missions Trip Registration Packet Name: Date: Included in this packet: 1. Personal Data Form 2. Medical Information and Release Form 3. Follow up trip evaluation 4. Sponsorship Letter
Cost of the Dominica Missions Trip DEPOSIT AND BALANCE The deposit must be submitted with your registration packet. The full cost of the trip is $1700.00. You may choose to pay your balance at any time before the deadlines listed below. Payments can be made with your credit or debit card through the church s website www.livingwatersmd.org/donations. Registration (Due now) - $100.00 January 31, 2015 - $500.00 April 30, 2015 - $1000.00 June 30, 2015 - $1700.00 PASSPORT A passport is required to travel to the island of Dominica. - Apply now for your passport To obtain a passport, you will need a certified birth certificate (not the hospital record), two passport photos and a driver s license. In addition, you will need to pick up and fill out a form available at most post offices and turn in the information to the postal clerk or the court house clerk for processing with the U. S. Passport Agency. Costs may vary depending on when you apply. You should allow six to eight weeks for your passport to arrive. Also, remember that it sometimes takes state agencies several weeks to provide a certified record of your birth if you do not currently have one. Further passport services and information is available at http://travel.state.gov/passport/passport_1738.html IMMUNIZATIONS No particular immunization is required to travel to Dominica. It is always advisable to discuss your travel plans and personal health with a health-care provider. 2 P a g e
Policies and Procedures 1) You must submit this completed registration packet AND a non-refundable deposit before your travel arrangements will be made. 2) Participants must adhere to rules outlined in the team covenant. Please read it before submitting your registration packet. 3) No one will be considered or accepted as a team member until a completed registration form and deposit are received. 4) Mission trips can be rewarding and life-changing; however, they can also be stressful. Please consider factors in your personal life at this time that may distract and prohibit you from fully committing to the mission of the trip and adapting to unusual conditions. 5) Once your registration packet and deposit has been submitted, the team members are expected to attend all mission trip meetings. 3 P a g e
TEAM COVENANT 1. Remember that I am representing Jesus Christ as well as Church of Living Waters. I will model Jesus in my behavior and attitude. 2. Remember that I am a guest working at the invitation of my hosts. I will remember the missionary s prayer. Where you lead me I will follow; what they feed me I will swallow 3. Remember that we have come to learn, as well as to teach. I ll resist the temptation to inform our hosts about how we do things I ll be open to learning about other people s methods and ideas. 4. Respect the host s view of Christianity recognizing that Christianity has many faces throughout the world and that the purpose of this trip is to experience faith lived out in a new setting. 5. Develop and maintain a servant attitude toward all nationals and my teammates. 6. Refrain from a showy, arrogant posture toward the nationals and my teammates and I will continually promote a positive, supportive, and encouraging environment. 7. Respect my team leader(s) and his or her decisions. 8. Refrain from a complaining criticizing attitude toward the nationals, team leaders and my team mates. I know that travel can present numerous unexpected and undesired circumstances, but the rewards of conquering such circumstances are innumerable. Instead of whining and complaining, I ll be creative and accommodating and promote a team environment without judgment. 9. Attend all team meetings before the trip as well as any follow-up meetings. 10. Remember not to be exclusive in my relationships. If my boyfriend, girlfriend, spouse or good friend is on the mission team, I will make every effort to interact with all the members of the team. 11. Refrain from illegal drugs and abstain from consumption of alcoholic beverages while on this trip. 4 P a g e
12. Refrain from leaving the hotel or group for night activities or non-church sponsored evening activities. 13. Refrain from the use of inappropriate or obscene language. 14. Refrain from the teaching or practice of any belief that would not be endorsed by Church of Living Waters. 15. I will refrain from wearing any clothing that may be viewed as inappropriate or revealing. 16. Remember that I can be sent home or excluded from team activities if I break this covenant. Signature Date Please keep a copy of this Covenant for your records. 5 P a g e
Adult Release and Indemnification Agreement REQUIRED FOR EVERY MISSION TEAM MEMBER In consideration of the undersigned s registration packet for participation in a mission trip sponsored by Church of Living Waters, Oxon Hill, Maryland, ( the Church ) and as an inducement to organizing the mission trip and permitting participation the undersigned agrees as follows: The undersigned hereby fully and forever releases and waives and agrees not to cause to be brought any and all claims, demands, actions, or causes of action of every possible kind and nature whatsoever the undersigned might assert, including without limitation, claims for personal injury, wrongful death, or property damage, whether or not absolute, now or unknown, or otherwise against the Church or any of its stewards, elders, officers, employees, agents and volunteers (collectively referred to herein as the Releasees ) by reason of, arising out of or relating to the undersigned s participation in the church mission trip. The undersigned further agrees to indemnify, defend and hold the Releasees harmless from damages, including, without limitation, special, incidental and consequential damages, losses or expenses suffered or paid, directly or indirectly, as a result of any and all claims, causes of actions, suits proceedings, demands, judgments, assessments, and liabilities, including reasonable attorneys fees incurred in litigation or otherwise, assessed incurred or sustained by or against the Releasees by reason of, arising out of or relating to the undersigned s participation in a Church mission trip. The undersigned further agrees that this Release and indemnification Agreement (the Agreement ) is binding upon the undersigned s heirs, executors, administrators, assigns and legal representatives; that this Agreement releases all successors, assigns and legal representatives of the Releasees; and that this Agreement is to be governed by the law of the state of Maryland. The undersigned further agrees that the execution of this Agreement is continuing in nature; it is the undersigned s knowing and voluntary act the undersigned does not intend to participate in the mission trip until and unless the undersigned has had full opportunity to the undersigned s satisfactions to inspect and determine the scope of the mission trip and receive all information from the leader or the Church which bear on the undersigned s decision to participate; and the undersigned is under no duress or undue influence to execute this Agreement. The undersigned hereby grants full permission to the Church to use any photographs, videotapes, motion pictures, recordings, or other records or documents of the mission trip and to do so without notice or compensation to the undersigned. The undersigned acknowledges that it is his/her responsibility to purchase the travel insurance for the trip. The undersigned assumes responsibility to pay any outstanding balance upon request by the Church; and agrees that any and all costs incurred by the undersigned during the mission trip, including, without limitation, costs due to health problems, emergencies and death, are the responsibility of the undersigned or estate of the undersigned. The undersigned certifies that the information provided in the undersigned s registration packet for participation in the Church mission trip is true, complete and correct and acknowledges that the undersigned has read and understands this Agreement; that the undersigned has not relied in signing this agreement on any statement, oral or otherwise, by the Church; and that it is the undersigned s intention with this Agreement to make a complete, general and unconditional release of any and all claims whatsoever against the Releases as set forth above. IN WITNESS WHEREOF, the undersigned hereby executes this Agreement on the date set forth below: DATE: SIGNATURE: PRINTED NAME: 6 P a g e
I understand and agree to the following policies: REQUIRED FOR EVERY MISSION TEAM MEMBER I have included my deposit that is due with this completed registration packet and I understand that the deposit and all contributions are not refundable. I have read and accept the Policies and Procedures and Consider the Cost of the Missions trip If I cancel after the final travel arrangements have been made, I am responsible for full payment of the trip. I have read and signed the Team Covenant. I will adhere to the Team Covenant. I have read and signed the Release and Indemnification Agreement I commit to attending and participating in the mandatory Mission trip meetings that I ve applied for. I understand and authorize that a possible background / sex offender check may be completed on me. Signature Date 7 P a g e
DOMINICA MISSION TRIP Submit to: Church of Living Waters (Mission Trip) 4915 Wheeler Road Oxon Hill, MD 20745 Office Use Only Date Rec d: Check # Amount $ Personal Data Please print name as it appears on your passport or ID (Please print very clearly or type) Legal name: (Last) (First) (Middle) Passport # Exp. Date: Issue Date Nickname: Address: (Street) (City) (State) (Zip) Email Address: Cell Phone: ( ) Home Phone: ( ) Work Phone: ( ) Legal name(s) of family members attending the mission trip as it appears on their passport or ID Parent/Guardian/Spouse: (Last) (First) (Middle) Child: (Age) (Last) (First) (Middle) Child: (Age) (Last) (First) (Middle) Child: (Age) (Last) (First) (Middle) Child: (Age) (Last) (First) (Middle) Minors traveling without both of their biological parents will need a notarized Unaccompanied Minor form to travel out of the country. This form should not be turned in to the office and should stay with the identification paperwork of the traveling individual.
Medical Information & Release Copies of your insurance card must accompany this form. Please complete one entire registration form for each family member attending. Name: Birth Date: Address: City: State: Zip: Home Phone ( ) Work Phone ( ) Medical Insurance Provider ID # Will your medical insurance cover you out of the country? Yes No Name of Primary Physician: Address: City: State: ZIP: Phone ( ) Emergency Local Contact: City: State: ZIP: Home Phone ( ) Work Phone ( ) Please check if you suffer from any of the following medical conditions Hypertension Hypoglycemia Bleeding Disorders Heart Disease Seizures Insect Allergies Asthma Chronic Anxiety Arthritis Diabetes Depression Glaucoma Migraines Phobias List Physical Limitations Please List List any medications (prescription or OTC) taken on a regular basis: List Medical & Food Allergies: Blood Type Have you had any surgery in the past three years Yes No If so, please explain: In an emergency, I give my permission to a licensed physician to hospitalize or anesthetize me, or perform surgery on me. I understand that every effort will be made to inform my emergency contact before these actions are taken. Signature: Parent/Guardian Signature: Relationship to Participant: (only if participant is under 18 years of age) Date: Date:
Follow Up Trip Evaluation Form We appreciate your feedback. Please help us to evaluate the Trip by taking a few minutes to fill out and submit this form. (Attach additional sheets if necessary) Name: (optional) Mission Trip Location Dates 1. Was this your first short-term mission trip? Yes No 2. What was your overall view of the mission trip? 3. Would you like to go on another trip? Why / Why Not?
4. On the trip, did you see the Lord do a great work? Through you? Explain 5. Now that you are back home, you re likely to ask is What s next, Lord? Is God leading you to a deeper commitment to Himself? Do you feel drawn closer to your Creator? Do you feel the need to make some changes in your life as a result of the trip?
6. What did you learn on this trip that might be beneficial information for future Team Members 7. Evaluate the following areas of the mission trip logistics from a scale of 1 (poor) to 5 (excellent), having NA for non-applicable items. This feedback will help us continue to grow and improve in mission trip development and execution. Score the items, which applied to your trip. Pre-Trip Information and communication Travel Arrangements Work site Project(s) organization Team camaraderie Supplies Transportation Meals Daily devotions Training and preparation for the trip Hotel Accommodations Cultural Immersion Daily Organization Daily Schedule Leadership support and encouragement Nightly Activities Fellowship Opportunities Other:
Please comment on any aspect of the trip that you appreciated or felt needs improvement: (attach additional sheets if necessary) Thank you for your time! Church of Living Waters Dr. Paul Carrette Senior Pastor
Church of Living Waters Mission Dominica Dear Friend, On July 18, 2015, I will be joining my church on a mission of mercy to the Caribbean island of Dominica. The intent of this trip is to offer a helping hand to the poor and needy on that island. Among the projects that we will be undertaking are the distribution of well needed medical supplies to hospitals and clinics, distribution of food to feeding programs and homeless shelters and delivering school supplies to hundreds of elementary school children on the island. The purpose of this letter is to request your assistance in helping me to raise the necessary funds to make this mission trip possible. I am responsible for the purchase of my airline ticket and my accommodations while on the trip. Your financial assistance in any amount would be highly appreciated. My church has arranged to provide you with a tax deductible receipt for any contribution you make towards this trip. Please make all the checks payable to Church of Living Waters. I look forward to your response. May God bless you! Sincerely, Your name here Approved by Rev. Dr. Paul Carrette Senior Pastor