Missions Trip Application

 

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Personal Information
First Name
Middle Name
Last NameFamily name
Preferred Name
Gender
Social Security Number
Date of Birth
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Mailing AddressStreet Address Only (Include Apt #)
Mailing AddressStreet Address Only (Include Apt #)
City
State
Zip
Primary Phone Number
Additional Phone Number
Occupation
T-Shirt Sizepick one
Have you been convicted of, or plead guilty to any criminal offense (other than juvenile offense now expunged from your record), or released from prison in the past ten years? Have you ever been convicted of or plead guilty to a felony?
Travel & Passport Information
Trip DateDeparture Date
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Name as it appears on Passport
Passport Number
Passport Date of Issue
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Passport Expiration Date
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Place of Issue (Country)
Please upload a COLOR COPY OF YOUR PASSPORT. Make sure that the Passport Number and all content is readable in your image.
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Travel: Please let us know what airport you would like to depart from.
Departure City and Airport #1
Departure City and Airport #2
Mission MYnded books all flights. However, if you have any flight deviation (ex: different return date) or you have an exception to book your own flight (ex: using your frequent flyer points), please indicate that here and our missions team will contact you:
Minor Information
Are you under the age of 18?
Experience
Please check the areas where you have previous experience:
Please list any other skills and talents that may be helpful on the mission field. Also use this space to elaborate on any of the above checked items.
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Have you served on any other mission humanitarian projects before?
Insurance
Supplemental traveler's insurance will be provided through an outside travel insurance agency.
Your Beneficiary
Checking the box below and giving the date serves as your signature. By doing so, you are agreeing to the following: If I am accepted for a Mission MYnded International project, I wish to make clear my understanding that Mission MYnded International does not assume any responsibility for loss of property, damage to the same, personal harm or illness that may come; I, for myself, my heirs, executor, administrators, distributes and assigns, in consideration of my admission to volunteer mission projects and other good and valuable considerations, do hereby absolve said Mission MYnded International and hold them harmless from any claim or demand which I or they might conceivably assert upon the basis of foregoing.
Date
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Medical Information
Do you have any existing physical condition which may require medical attention during your project?
Do you require a wheelchair at the airport?
Can you walk unassisted for at least 2 miles?
Medications Required(If none type NONE)
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Allergies(If none type NONE)
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Emergency Contact Information
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Cell Phone Number
Emergency Contact Additional Phone Number
References
Please select two individuals as references. Good examples of references are a church staff member, campus minister, youth minister, co-worker, friend, someone who has observed you in a situation related to this type of trip, or someone who has observed your spiritual life/growth. Please do not list relatives or household members.
Reference #1
Name
Relationship
Primary Phone Number
Additional Phone Number
How long have you known this reference?
Reference #2
Name
Relationship
Primary Phone Number
Additional Phone Number
How long have you known this reference?
Team Manual Agreement
Checking the box below and giving the date serves as your signature. By doing so you are agreeing to the following: I, hereby agree to read and abide by the Code of Conduct, Rules and Guidelines, Dress Code, etc. stated in the Mission MYnded Training Guide.
Date
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Final Agreement & Signature


Our Mission: Meet the physical, spiritual, and social needs of impoverished communities around the globe with an emphasis on Evangelism, Education and Empowerment.


Conditions of Volunteer Participation and Release from Liability: Mission MYnded is dedicated on building a community of empowered volunteers committed to developing into servant leaders both physically and spiritually. As a volunteer, I will cooperate in the fulfillment of Mission MYnded’s vision, while encouraging others to participate in this worthwhile campaign of bringing hope to people in need around the globe. Minors under the age of 16 who plan to travel without a parent or guardian must seek approval from the Mission MYnded office. For more information, please visit www.missionmynded.org, or call 704.567.9700 or e-mail info@missionmynded.org.



Background Certification: I certify that all of the information provided on this application is true and complete. I authorize the Mission MYnded staff to investigate and verify any and all of the information I have submitted. Because Mission MYnded strives to provide a safe environment for children and youth, I understand that Mission MYnded may order a criminal history check, and I authorize this investigation. Mission MYnded reserves the right to deny any application due to results of background check.


Volunteer TermsI agree to abide by Mission MYnded’s policies, procedures and Code of Conduct. I understand Mission MYnded does not provide any health benefits (i.e. medical, dental, workers compensation, etc.) or any accident insurance for me as a volunteer; I understand it is my responsibility to provide this coverage. I understand that Mission MYnded does not provide volunteer compensation or trade volunteer services for paid mission trips.


Property Loss: I understand Mission MYnded is not responsible for my personal property lost, damaged or stolen while participating in Mission MYnded volunteer activities.



Baggage: On occasion, your checked baggage can be used to bring Mission MYnded mission supplies into the host country. Personal items may need to be packed in a carry-on bag. Your team leader will inform you of this, if that is the case.



Medical Treatment: I give permission for Mission MYnded representatives to provide or arrange for emergency care for me, and to arrange for transport to an emergency medical center for treatment. I consent to medical treatment deemed immediately necessary or advisable by a physician if I am unable to act on my own behalf. I further understand that Mission MYnded is not responsible for payment for such medical treatment.


Photograph or Digital Image Permission: I give permission for Mission MYnded to use, without limitation or obligation, photographs or other media that may include my image or voice to promote or interpret Mission MYnded programs.


Release from Liability: I understand that accidents may occur during my volunteer activities. By signing below, I release the Mission MYnded, its agents, directors, consultants, and employees from all liability based on any damage, loss or injury, whether it is the result of ordinary negligence or otherwise, caused to me or my dependent from participation as a volunteer.

Checking the box below and giving the date serves as your signature. By doing so you are agreeing to the following: I, hereby agree to the terms listed on this page including Conditions of Volunteer Participation and Release from Liability, Background Certification, Volunteer Terms, Property Loss, Baggage, Medical Treatment, Photograph or Digital Image Permission, and Release from Liability
Date
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Personal Testimony
The personal testimony. Take time to tell us why you feel called to serve on a mission project, how God or your faith has played a part in your decision, and who God is to you.
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