Are You Ready for the Opportunity of a Lifetime? Prayerfully Consider Joining the Vida

Are you ready for the opportunity of a lifetime? Prayerfully consider joining the Vida Joven service learning team! We will venture to Nicaragua for a week of prayer, hard work, and enlightenment.

Full Name: ______

Male ___ Female___

Address: ______

Date of Birth: ______Age: _____ T-Shirt Size: ______Phone: ______/ ______

Email: ______

Vida Joven Nicaragua July 30th-August 6th Estimated Cost: $2,000 Non-refundable deposit: $200

Minors (under age 18):

Father(name):______

Mother(name):______

Phone:______/______

Adults:

Emergency contact (name):______Relationship:______

Phone:______

MEDICAL INFORMATION/CONDITIONS

Doctor’s name: ______

Phone #: ______

List health concerns: medical history, diet, medications or allergies that leaders need to be aware of.

(Attach an additional page if necessary.)

Health Insurance Co: ______

Group/Policy #: ______

Date of last tetanus shot: ______As a participant or parent/guardian of a participant in the Vida Joven Mission trip, I hereby give my consent for emergency medical care prescribed by a duly licensed doctor of medicine or doctor of dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or wellbeing of my dependent.

Participant/Guardian signature: ______Date:______

Participant or PARENT/GUARDIAN AGREEMENT

I, the participant or parent/guardian of the registrant, a minor, recognize the possibility of physical injury associated with activities. In consideration for the trip accepting the registrant for its programs and activities, I hereby release, discharge and/or otherwise indemnify Vida Joven trip leaders, their employees and associated personnel, including the owners and directors of facilities utilized for the programs, against any claim by or on the behalf of the registrant’s participation in the programs and/or being transported to or from the same, which transportation I hereby authorize.

Participant/Guardian signature: ______

Date: ______

Notary Public signature: ______

Date: ______FAITH / PERSONALITY

1. Share a testimony and current relationship with Christ.

2. Share what ways are you involved at your church and other ministries.

3. Some mission trips are service/work experiences. These are ways Christians can witness and share their God given talents. What gifts/talents would you contribute to the group on this trip? List skills or personality traits that you feel are beneficial to this team:

4. List missions trips or service/work experiences you have had and when.

5. Why do you want to go on this mission trip and what do you expect to gain?

6. How do you handle corrective feedback or discipline?

7. A $200 non-refundable application fee (payable to Centerville Baptist church – memo line Vida Joven) is required with the application. Please attach an extra sheet of paper if needed to answer any of the above questions. Expectations:

•Have fun while at the same time...be flexible! •All team members must attend all pre/post training, meetings, and presentations or forfeit their place on the team. •Cost of obtaining Passport, VISA, and immunizations is an additional cost incurred by team members. •Be “on-time” when meeting times and places are set. This will keep all of us happy and “on-schedule” but ...be flexible! •Please follow directions the first time they are given. Respect the pastor/leaders and do what they ask if you are being corrected. •You are to do your share of assigned service/work as directed by leader/supervisor. •Team up with a buddy and remain with the group unless otherwise directed. •Use of tobacco, alcohol, or other drugs means that you forfeit your place on the team and will return home

For the Participant:

By signing this application, I ______understand that I am (and my parents) responsible for my deposit and inevitably the full cost of my trip. I promise to actively participate in fundraising and understand that the amount of my participation will affect my overall portion of the proceeds raised. At the end of fundraising, if the money raised it not enough to cover the trip, I will be responsible for paying the difference.

I also understand that preparation for this trip is crucial and promise to attend the mission trip meetings, fundraisers, in- service trainings etc. and fulfill all of the requirements for participation. If I fail to meet these requirements, I understand that I may be asked to give my spot to another participant who can fulfill the requirements.

Finally, I agree to participate fully in the mission trip regardless of what obstacles we may encounter. I understand that mission work is hard and promise to give of my whole self, allowing Christ to work through me. I understand that housing may be uncomfortable and they environment may be extreme and unforgiving, food may be different and limited and I fully welcome these challenges and opportunities.

Participant Signature: ______

For the Parents (if minor is participating):

By signing this application I (the parent) understand that my family is responsible in supporting my child monetarily, physically, spiritually, and mentally. I promise to help the participant in raising the funds and participating in the mission trip meetings to the best of my ability. I promise to attend/chaperone fundraisers. I understand that we are responsible to cover the cost of the trip if the funds are not fully raised by fundraisers.

I promise to help keep track of times and dates to insure that my child is on time to meetings and events. I will do everything in my power to kleep the leadersip of the trip informed of any conflicts or issues. I understand that my child may be asked to give up their spot on the trip if we fail to meet the minimum requirements.

Finally, I understand that my participation and encouragement is vital to the overall group mentality. I agree to support my child and the mission group in this mission trip in every way that I can.

Parent signature(s): ______

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