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 2010 Application-better to have emailed, but this will work
A $150 non-refundable deposit is REQUIRED in addition to this application. Space is limited. Return date and deposit helps determines order.
Trip is open to students grades 9 -12 and at least 14 years old. STUDENT INFO Shirt Size S M L XL 2XL Full Legal Name:_________________________________________________ (For
Address:________________________________________________________City ____________________________
State__________ Zip____________ Home Phone:______________________ Date of Birth: ___________________
School: ____________________________ Grade:
We send meeting reminders, updates and information as many ways as to keep you up-to-date. An email address you actually read is very important. Also we will send you texts but only of you say it is ok.
Student’s Email:____________________________________ Cell #:_____________________ OK to Text You: Y N
Passport: Yes No Expires: ____________ Issuing Country:_____________________Citizenship:_____________
PARENT INFO
Parent or Guardian’s Name: _______________________________________________________________________
Address: ______________________________________________________________________________________ (we’ll send Home Phone:__________________ Email Address: _______________________________________ them info too) Cell Phone:_____________/ _____________ Work Phone: _____________/____________ (Mother / Father) (Mother / Father)
Non-Parent Emergency Contact Name: ______________________________________________________________
Address: ______________________________________________________________________________________
Home Phone:____________________ Cell Phone:__________________ Work or Alt Phone:__________________
MINISTRY BACKGROUND
Tell us about any outreach ministries (including mission trips) you have been involved with and what leadership positions have you held in school or in church.
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Where do/have you worked and what are/were your duties? _________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Why do you want to go on this trip? _________________________________________________________________
_________________________________________________________________________________________________________
What is the most important thing you will be able to contribute to this trip? __________________________________
_________________________________________________________________________________________________________
What things would you like us to do on this trip? _______________________________________________________
_________________________________________________________________________________________________________ MINISTRY SKILLS AND INTERESTS
Rate your skill level in each area, first for the general ministry (construction, personal, other) in an overall sense, then with the specific skills below the general ones. Finally, tell us if you are interested in this area of ministry.
1 = Never done this 2 = Done it but not much or not very skilled 3 = Have pretty good knowledge of it 4 = Done it before & can do it again with little help 5 = All over it! Do this all the time
YOUR INTEREST RATING YOUR SKILL RATING Doing Leading [1-No, 2-Maybe, 3-Yes!] Construction Ministry (in general) 1 2 3 4 5 1 2 3 Yes No
- Masonry 1 2 3 4 5 1 2 3 Yes No
- Carpentry 1 2 3 4 5 1 2 3 Yes No
- Drywall 1 2 3 4 5 1 2 3 Yes No
- Electrical 1 2 3 4 5 1 2 3 Yes No
- Plumbing 1 2 3 4 5 1 2 3 Yes No
- Painting 1 2 3 4 5 1 2 3 Yes No
- General mechanical (fixing things) 1 2 3 4 5 1 2 3 Yes No
VBS/Personal Ministry (in general) 1 2 3 4 5 1 2 3 Yes No
- VBS overall coordination 1 2 3 4 5 1 2 3 Yes No
- VBS performing dramas & skits 1 2 3 4 5 1 2 3 Yes No
- VBS song service 1 2 3 4 5 1 2 3 Yes No
- VBS telling children’s stories 1 2 3 4 5 1 2 3 Yes No
- VBS crafts 1 2 3 4 5 1 2 3 Yes No
- Giving a sermon at church 1 2 3 4 5 1 2 3 Yes No
- Singing as part of a choir 1 2 3 4 5 1 2 3 Yes No
- Special music for church 1 2 3 4 5 1 2 3 Yes No
Team Support & Other Ministry 1 2 3 4 5 1 2 3 Yes No
- Health/healthy living instruction 1 2 3 4 5 1 2 3 Yes No (dental care, HIV prevention…)
- Medical Team (1st Aid) 1 2 3 4 5 1 2 3 Yes No
- Organizing, details 1 2 3 4 5 1 2 3 Yes No
- Doing our daily Blog 1 2 3 4 5 1 2 3 Yes No
- Videography & slide shows 1 2 3 4 5 1 2 3 Yes No
- Doing a worship for our team 1 2 3 4 5 1 2 3 Yes No
Other skills and interests you may be able use on this trip: ________________________________________________
______________________________________________________________________________________________
What instrument(s) do you play? ____________________________________________________________________
And would you be willing to bring that instrument(s)? ____________________________________________________ My desired ministry mix is: (place X in scale) |___________________________________________________________________________________________| 100% Construction 50/50 100% Personal/Spiritual
Applicant’s Mission Trip Agreement – Please Read Carefully I pledge to
Ø A. Keep a positive, cheerful attitude, and remember the goal of this trip is to serve and minister to others. I will serve when, and in the way, asked of me without complaining or delay.
Ø B. Obey all rules, respect the adult leaders and act in a manner consistent with a Christian on a mission trip. I understand if I cannot my parents will pay for my early return, for the chaperone's ticket AND pay for the return of the chaperone to The Dominican Republic so he/she can continue the mission trip.
Ø C. Learn and respect the culture of the local church and the
Ø D. Uplift my fellow students -never putting them down, to experience fellowship and a Christ-like community with them. I will refraining from any public displays of affection and avoid the appearance of evil by staying together as a group.
_____________________________________________________________________________________________ Signature Printed Name Date
As pastor at
______________________________________________________________________________________________ Signature Printed Name Date Phone Number
As a _____________________ at _____________________________________ , I recommend the above student to participate in the Dominican Republic Mission Trip.
______________________________________________________________________________________________ Signature Printed Name Date Phone Number
I recommend the above student to participate in the Dominican Republic Mission Trip.
______________________________________________________________________________________________ Signature Printed Name Date Phone Number
Once Fully Completed Return with deposit to:
Note on Deposits: Deposits are returnable only until November 1 and are transferable, with the approval of the mission team, until January 1. Applications received without deposits are not complete and not acted upon.
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