MERGE - Mission Trip Initial Registration

Please fill out the application below.

*Address Line 1
Address Line 2
*Zip/Postal Code
*Date of Birth (mm/dd/yyyy):
*Have you ever been on a mission trip before?:
*Why do you want to participate in this trip?:
Do you speak more than one language?:
*Describe how you came to Christ?:
*What does living "Life on Mission" mean to you?:
*Insurance Company
*Insured's Name
Group Number:
Primary Physician name / address / phone #:
*Emergency Contact Name / relationship / primary and work phone:
Medications and dosage that you are currently taking:
Please list all drugs / medicines which you are allergic::
Are you in good health? If not, please briefly describe any condition (physical or emotional) your leader should know about.:
Please list any unusual medical conditions that you feel it would be helpful for a physician to know in the event you were to re:
*Are you pregnant?:
If pregnant, how far along are you?:
EMERGENCY AUTHORIZATIONTO WHOM IT MAY CONCERN: I, the undersigned, hereby give any licensed, practicing physician or hospital full authority to provide emergency medical treatment for me in the event such treatment is needed or necessary and I am not able to make such a decision. I also hereby give my permission for a licensed practicing physician to administer whatever medical treatment he/she may deem necessary for me in the event of any medical emergency affecting me.
I.  Expectations: The purpose of taking teams abroad from Roswell United Methodist Church (RUMC) is to share the gospel of Jesus Christ in love, through word and deed, and to challenge our members in their personal walk with Jesus Christ. Any available sightseeing, shopping, or recreation will be permitted only if it does not conflict with the team’s specific purpose.  Standards of conduct, dress, and lifestyle will be explained in an orientation program. Team members and leaders will adhere strictly to these policies and can be subject to exclusion from this and future trips for violations, without refund or reimbursement. 
II. Finances: All applications and contributions are nontransferable. If an individual is unable to participate in the RUMC team experience for which s/he applied, the fund s/he raised for the trip, less incurred expenses and administrative fees, will remain credited to his/her account for one year for his/her use on another RUMC mission trip. In the event of political unrest or natural disaster, RUMC reserves the right to cancel the trip. In the event a trip is cancelled, team members will be offered another mission experience at a similar expense. All donations received by RUMC go toward tax-exempt project expenses. To receive a tax deduction, IRS stipulates that the donor must release control of the money donated to a non-profit organization. For this reason, money cannot be refunded or designated to a person. The team member will be a fund-raiser and receive credit for raising funds equal to the price of the trip.
III. Photo Release:  I give RUMC the right to use my picture, voice, and/or testimony in their promotional or advertising materials.
IV.  Release of liability: I, the undersigned, hereby acknowledge that by engaging in this mission, I am subjecting myself to certain risks voluntarily, in addition to those risks which I normally face in my personal and business life, including but not limited to such things as health hazards due to poor food and water, diseases, pest, and poor sanitation; potential danger from lack of control over local populations; potential injury while working, recreating or traveling; inadequate medical facilities; terrorist acts, etc.
*In consideration of being accepted by RUMC, for participation in this mission trip
I do hereby release, forever discharge, and agree to hold harmless RUMC, their agents, employees and officers, from any and all liability, claims or demands, which I or my heirs, executors, administrators, or assigns may have or claim to have, for personal injuries to property, real or personal, sickness, death, or unanticipated expenses of any nature which may be incurred by the undersigned participant, arising out of, or caused by, the above described mission trip or activity.  I intend to be legally bound by this statement of release. 
I will be sensitive to theological issues. 

I realize that the Christian faith manifests itself in different ways in different cultures. 

I will avoid criticizing or debating controversial theological issues.

I will always treat with respect my team leaders, fellow team members, in-country hosts, and nationals with whom we work. 

I will avoid criticizing my leaders, fellow team members, and hosts. 

I will avoid any romantic activity toward fellow team members or nationals. 

I realize that activity of this type could hinder the team witness and interfere with my own spiritual focus on this project. 

I will not make negative political comments about my host country or excessively talk about the greatness of my own country.  

I will also avoid criticizing things I do not like about my host country. 

I will never use profanity and abusive language. I will not use illegal drugs. 

I will also avoid watching or reading pornographic material. 

I will abide by the host church’s practice concerning alcohol and tobacco products. 

I am aware that this could very well mean that I will be unable to use them during my stay in their country. 

I will accept and do the jobs given to me without complaint. 

I will maintain my personal disciplines of prayer and Bible study during the project - even if it means doing it when I am tired and losing sleep. 

I will resist complaining when things go wrong or when I don’t like what is happening. 

I will always try to eat what is set before me without complaint (Luke 10:7-8). 

I will not isolate myself from nationals or missionaries during any free time, but will pursue fellowshipping with them. 

I won’t try to spend all my time with other volunteers. 

I understand that I am representing Christ and the local church while I am on this mission trip, and I covenant to act in a way that reflects this understanding and brings glory to God. 
*Electronic Signature
*Today's Date