Guatemala Mission Trip Info! Date: June 16-25, 2016 Cost: $1,900 (includes airfare, lodging, food, and supplies for the trip) Locaon: Chichicastenango, El Quiche, Guatemala Reslife Youth will be joining Michael and Chrisi Shead and ASELSI ministries in Chichicastenango for a week where will be ministering in the local churches and communi.es. Through service projects, ministry programs and house-to-house evangelism we will be bringing the love of God and the Gospel message to the people of Guatemala. Interested in joining us? Pray about if it’s a trip that God would have you go on this year. Then fill out an applica.on and turn it in! **Applicaons will be accepted starng November 29, 2015 at the Youth Info Table. No applicaons are being received before this me. Spots are reserved on a first-come, first serve basis, but are subject to the approval the Youth Staff. A $100 deposit must be submi1ed with your applicaon to be accepted. Checks may be made out to “RLC.” Please do not put anything in the memo secon.
Michael & Chrisi Shead and Family For ques.ons or more informa.on contact Kendra at
[email protected] or (616) 261-3766.
Missions Trip Application
Guatemala 2016
Dates: June 16-25, 2016 Cost: $1900 We are excited about your interest in the Guatemala 2016 Mission Trip for ResLife High School Students. Please read carefully through the information below and fill out the attached pages.
• The entire application must be completed to be considered for acceptance. Acceptance for this trip is subject to the review and discretion of the Reslife Youth staff. • A separate application must be completed for each person desiring to apply, including children. • Please print clearly in black or blue ink. Turn in the following items to apply: 1. The Reslife Missions Application 2. The RLC Student Waiver/Release of Liability. 3. A $100 non-refundable deposit. o Make check payable to RLC, no name in the memo section. o You are unable to have a place reserved on the trip without this deposit. 4. On a separate piece of paper, please provide a one-page written testimony of your relationship with God.
• Upon your acceptance to the trip, you are agreeing to pay the total cost of $1900 (includes the deposit) as follows:
•
• •
o $100 (non-refundable deposit due with application) o Full amount by 05/01/16 o (All funds donated to mission trips are non-refundable and non-transferable.) All donations by check should be made out to RLC and turned in the the Reslife Youth staff. A donation should contain a separate note with the students’ name. There should be nothing written in the memo section on a check – this ensures that the donation is tax-deductible for the sponsor. Do not place ANY trip payments in the church offering collection. (There is a link on getfloored.org for online donations via credit/debit card.) Understand that you are responsible to cover all costs for this trip, and are agreeing to do so according to the time frames noted above. If a student does not cover their costs as described above, their place on the trip may be forfeited and given to another student.
___________________________________________________________________________________________________
Thank you for your interest in ResLife Missions! Please return your completed application to the Youth Info Table, Student Ministries office or mail to: Resurrection Life Church | Attn: Kendra Binish | 5100 Ivanrest Ave SW | Grandville, MI 49418 You will be contacted soon concerning your application. For any immediate questions or concerns, contact: Kendra Binish (616) 261-3766 or e-mail:
[email protected].
Youth Missions Trip Application – Guatemala 2016 • Entire application must be completed to be considered for acceptance. Acceptance for this trip is subject to the review and discretion of the Reslife Youth staff. • Please print clearly in black or blue ink. Please return your completed application to the Youth Info Table or mail to: Resurrection Life Church | Attn: Kendra Binish | 5100 Ivanrest Ave SW | Grandville, MI 49418
Personal Information / Full Legal Name
M Birthdate (Month/Date/Year)
Current Grade
/
F
Gender (circle one)
Street Address
(
/
Today’s Date
Yes
/ No
Are you a U.S. citizen?
If not, please write in correct country above.
City
)
(
State
)
Student Phone
Parent Phone
Best time to reach you?
Student E-Mail Address
(
Zip Code
)
Home or Other Phone
Occupation
Parent E-Mail Address
Name of Employer
Do you have a passport?
Church you attend?
High School
Graduation Year
Name of Pastor
# of years attended
Emergency Contact Emergency Contact Name
(
)
Home Phone
Relationship to You
( Cell Phone
)
(
)
Work Phone
Email
Additional Information Do you have musical or other talents? If so, what?
Have you been on a mission trip before? If so, where and what did you do?
Why do you want to go on this trip? (Attach additional paper if necessary.)
Continued on Reverse Side
Medical Info ** It is required that you are up to date on your Tetanus Booster to attend this trip and it is recommended that you have taken Hepatitis A, Hepatitis B and a Typhoid Vaccine. ** Because of the physical and climate conditions of this trip, students with breathing or heart related conditions are encouraged to look into our other missions option. They may still apply, but for their safety may be denied acceptance on the trip.
(
)
Insurance Company’s Name
Phone
Insurance Policy Number
Insurance Group Number
Physician’s Name
Phone
(
)
Are you up to date on your Tetanus Booster? Y / N This trip may be physically demanding with manual labor. Is there anything that would hinder you in regards to this? If so, please explain. ____________________________________________________________________________
_____
_______________________________________________________________________________________________________
_____________
Please note any recent medical history (asthma, allergies, recent injuries or surgeries, etc.):
Please list any prescriptions you will have with you while on the trip:
SECTION TO BE FILLED OUT BY PARENT Is the student allowed to hold and administer their medications themselves? Do you (parent) allow the missions leaders to administer over-the-counter medications to your student if they need or ask for them (i.e. ibuprofen, dramamine, pepto-bismol, etc)? Do you (parent) need to be contacted before student receives any emergency medical treatment?
Yes ________________ No _______________________ Parents Initial Parents Initial Yes ________________ No _______________________ Parents Initial
Parents Initial
Yes ________________ No _______________________ Parents Initial
Parents Initial
Agreement – Please initial each item below I will do my best to follow the leadership designated by the church for this project. I will pray regularly for God’s purposes to be successfully achieved on this project, both spiritually and materially. I agree to pay the total cost of $1900 (includes the deposit) by 05/01/16. (All funds donated to mission trips are non-refundable and non-transferable. ) I will not place ANY trip payments in the church offering collection. I am able to fully participate in the Resurrection Life Church Missions Trip. I will not hold Resurrection Life Church responsible in case of accident, injury or illness. I give permission for trained medical personnel to provide routine medical care and/or emergency medical treatment and I authorize Resurrection Life Church Team Leaders to sign consent forms for such treatment in the event that I am unable to do so. I understand that I am responsible to cover all costs for this trip, and I agree to do so according to the time frames noted above. / Applicant’s Signature (as appears on birth certificate)
Today’s Date
Parent/Guardian’s Signature (if applicant is a minor)
Today’s Date
/
Thank you for your interest in Resurrection Life Church Missions. You will be contacted within 3 weeks from our receipt of this application. For any immediate questions or concerns contact Kendra Binish (616) 261-3766 or e-mail
[email protected].
/
/
2016 STUDENT WAIVER/ RELEASE of LIABILITY In consideration of being allowed to participate in the Youth Missions trip to Chichicastenango, Guatemala June 16, 2016 – June 25, 2016 (“Missions Trip”) through Resurrection Life Church (“RLC”), I do hereby waive, release and forever discharge RLC, its officers, agents, employees, representatives, executors, and all others acting on their behalf from any and all responsibility or liability for injuries or damages resulting from my participation in the Missions Trip to the fullest extent permitted by law. I assume the risks – both known and unknown -- inherent to any and all activities I engage in while on the Missions Trip. I understand that this waiver and release of liability is binding during any and all activities related in any manner to the Missions Trip, including those leading up to the trip, during the trip, or in debriefing time following the Missions Trip. I also release and forever discharge RLC, its officers, agents, employees, representatives, executors, and all others acting on their behalf from any and all responsibility or liability for damages or loss of personal belongings brought on or purchased during the Missions Trip. I intend that the laws of Michigan are the governing laws to apply to this waiver and release of liability. By signing below, I acknowledge that I have read and understand the above information. Signature:__________________________________________________________________
Printed Name: ___________________________________________________________ Today’s Date:_______________________________ Permanent Address: ___________________________________________________________ Street Address
City
State
Zip
Birth Date:______/______/_________ If under 18 years of age: signature of parent or legal guardian is required: Parent’s Signature: ____________________________________________________________ Printed Name: ______________________________ Relationship to Minor: _____________ Home or Cell Phone:_________________________ Email: ___________________________
