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SUMMIT CHRISTIAN CHURCH’S

SHORT-TERM MISSIONS APPLICATION

Summit Christian Church


7075 Pyramid Highway
Sparks, NV 89436
(775) 424-5683
summit.go.team@gmail.com
Summit Christian Church Missions

7075 Pyramid Highway, Sparks, Nevada 89436

775.424.5683

e-mail: summit.go.team@gmail.com

Thank you for your interest in a short term mission’s trip. This packet contains your application,
dates of the pre-trip classes, and some information that will be helpful to you now. As the pre-trip
classes begin, we will help you with your support letters, and other information that will be helpful
in your preparations.

At this time, the cost of the trips are approximate. There are factors that have to be considered
such as the number of team members, the skills of the team, and the supplies we will need to bring
the work. But to give you a ball park figure, the trips will be approximately $3,000 U.S. per
person.

After you completely fill out the application, please turn it in to the church office. It will be
reviewed, and you will get a call from a mission’s team member for an interview. By submitting
an application, there is no guarantee that you will be selected for the trip. If you are not selected,
then the $100 deposit will be returned to you.

Applicants must be 18 years of age, or if accompanied by a parent, must have completed a year of
high schools. All applicants must be in good health, must have accepted Jesus Christ as their Lord
and Savior, and attend Summit Christian Church. Consideration will be made for those who attend
other churches, depending on the application process and at the Mission’s team’s discretion.

You will notice the attached calendar with dates of the pre-trip classes. You will be required to
attend all classes, so please take a look to see what your commitment is to the trip and to the team.

If you have questions, please use the mission’s e-mail address: summit.go.team@gmail.com

We are praying that God chooses each one for the teams, and are in much prayer through this
selection process. We encourage you to gather a prayer team just for yourself, as you go through
the steps of the application, prepare for the trip, and especially as you are overseas.

God bless you,

Summit Missions Team


Consider the Cost of Short-Term Missions
Fund-raising is an integral part of your short-term mission experience. Don’t let money keep you from
applying for a short-term trip… God could be waiting for an opportunity to show you how big He is!
Detailed fund-raising guidelines and materials will be provided at trip meetings.
Here are some inevitable costs that are your personal responsibility and separate from the cost of the
mission trip.

DEPOSIT & BALANCE


• The $100 deposit that is submitted with your application is your responsibility. In addition, if your fund-
raising efforts are not entirely successful, the balance of the trip cost is also yours to pay.

PASSPORT
• Required for all trips out of the continental U. S. Apply now for your passport!
• To obtain a passport, you will need a certified birth certificate (not the hospital record), two passport
photos and a driver’s license. In addition, you will need to pick up and fill out a form from the post office
and turn in the information to a postal clerk for processing with the U. S. Passport Agency. All of this can
cost $65 - $100, depending on when you apply. You should allow six to eight weeks for your passport to
arrive. Also, remember that it sometimes takes state agencies several weeks to provide a certified record of
your birth if you don’t currently have one.
• Further passport services and information is available: http://travel.state.gov/passport_services.html

IMMUNIZATIONS
• Summit’s Missions Ministry supports the immunizations that are recommended by the Center for Disease
Control. Check the diagram to determine which vaccinations are recommended and consult your physician
or the International Travel Clinic to determine costs.
• Vaccinations are not included in the price of the trip.
• Choose any medical provider at least 4–6 weeks before your trip to allow time for shots to take effect.
• Recommended vaccinations for all trips: Hepatitis A & B, Measles/Mumps/Rubella
(*if born after 1956), and Travelers Diarrhea RX
• Required vaccinations for all trips: Tetanus/Diptheria
• Look at the chart below for other recommendations for your trip. (Recommended vaccinations may
change as conditions change in various countries — verify this information with your medical provider.)
Summit Christian Church’s Short-Term Missions

POLICIES & PROCEDURES

If you are interested in participating in a short-term mission trip with Summit Christian Church
please read the following:

· You must submit this completed application and a $100 deposit before your application
will be processed and reviewed. After your interview, if you are selected for a short term
mission’s team, the deposit will become non-refundable. If you are not selected for the
team, the deposit will be given back to you.

· You will be required to sign a team covenant and must adhere to the rules outlined in
this covenant.

· No one will be considered or accepted as a team member until a completed application


and deposit are received.

· Your application will be reviewed by members of the Summit Mission’s Team and you
will be called for an interview. This may be in person, or in some cases, over the phone.

· Short-term mission trips can be rewarding and life-changing; however, they can also be
stressful. Please consider factors in your personal life at this time that may distract and
prohibit you from fully committing to the mission of the trip and adapting to unusual
conditions.

· Once accepted, team members are expected to attend all team meetings.

· All trip costs are the team member's responsibility and due two weeks prior to
departure. Your team leader will suggest ways to raise financial support; however, if full
support is not raised, the balance is your responsibility. You may not begin to raise funds
until you are notified of acceptance to the team and informed of proper fund raising
procedures.

· If you are unable to participate in your trip, the Missions Team must receive
cancellation notice as soon as possible. You may be responsible for all trip costs. Monies
put towards mission trips are contributions, and the Internal Revenue Service prohibits the
refund of contributions.
· If you have physical limitations, please apply for a trip in which you are physically able
to participate. Some trips may be prohibitive for certain physical conditions. Please make
the Missions Team and your team leader aware of these conditions.

· Team members will be given information regarding passports and vaccination


recommendations from the Department of Health and/or the missionaries on the field.
Passport and vaccination costs are not included in the trip costs and are the responsibility of
the team member. Team members assume the responsibility and liability for their personal
health decisions.

· Additional information regarding the price and dates for each mission trip is available
from the Missions Team. Team meetings are designed to inform and prepare you for the
mission.

I have read and understand Summit Christian Church’s Short-Term Mission’s Policies and procedures

Signature . Date .

Mission’s Team Member .

Comments _.
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Team Covenant
As a member of this team, I agree to:

1. Remember that I am representing Jesus Christ as well as Summit Christian Church. I will model
Jesus in my behavior and attitude.
2. Remember that I am a guest working at the invitation of my hosts. I will remember the missionary’s
prayer, “Where you lead me I will follow; what they feed me I will swallow.”
3. Remember that we have come to learn, as well as to teach. I'll resist the temptation to inform our
hosts about “how we do things.” I'll be open to learning about other people’s methods and ideas.
4. Respect the host’s view of Christianity recognizing that Christianity has many faces throughout the
world and that the purpose of this trip is to experience faith lived out in a new setting.
5. Develop and maintain a servant attitude toward all nationals and my teammates.
6. Respect my team leader(s) and his or her decisions.
7. Refrain from gossip.
8. Refrain from complaining. I know that travel can present numerous unexpected and undesired
circumstances, but the rewards of conquering such circumstances are innumerable. Instead of whining
and complaining, I'll be creative and supportive.
9. Attend all team meetings before the trip as well as any follow-up meetings.
10. Remember not to be exclusive in my relationships. If my boyfriend/girlfriend or spouse is on the
team, we will make every effort to interact with all the members of the team. If I am attracted to a
teammate, I will not attempt to pursue a relationship until after we return home.
11. Refrain from any activity that could be construed as romantic interest in a national or teammate.
12. Refrain from illegal drugs and abstain from consumption of alcoholic beverages or the use of
tobacco while on this trip.
13. Observe and practice the Summit Christian Church Statement of Faith.
14. Refrain from the teaching or practice of any belief that would not be endorsed by Summit
Christian Church (infant baptism, etc.). For clarification or if unsure about this issue, please talk to the
Summit Missions Team leader(s) or pastoral staff.
15. I agree to abide by the fund-raising procedures endorsed by Summit Christian Church and will
personally thank all financial donors that contribute to my trip.
16. Remember that I can be sent home if I do not adhere to this Covenant or if my Team Leader
believes it is in my best interest or that of the team.

Signature: _______________________________________________

Date: ___________________________

Please sign to show your commitment to this covenant and keep this for your
personal reference.
OFFICE USE ONLY:
Date App & Dep Rec’d:_________________
Sent to TL____________________________
Reply from Team Leader:________________
Trip:_________________________________
Communication w/ Team Leader __________

ENCLOSE deposit of $100. TRIP:


(non-transferable and non-refundable) 1st choice ____________________________
2nd choice ___________________________

The information on this form will be kept confidential and is for use by the Summit Christian Church Missions Ministry only.

Personal Data (Please print or type)


Legal name: __________________________________________________________________________
(Last) (First) (Middle) (As it appears on your passport.)
Nickname: ___________________________________________________________________________
Address: _____________________________________________________________________________
(Street) (City) (State) (ZIP)
Email Address: ________________________________________________________________________
Home Phone: ( )____________ Work Phone: ( ) ______________
Place of Birth: ______________________ Date of Birth: ___________________Age: ___________
__ Male __ Female Marital status: __ S __ M __ D __ W
Do you have a criminal record? __ Yes __ No If yes, please explain:_________________________
T-shirt size __ Small __ Medium __ Large __ X-Large __ XX-Large
Ages of children (if applicable):
_____________________________________________________________
If under 18 years of age — Name(s) of parent(s) or guardian(s):
______________________________________
Home Phone: ( )___________________ Work Phone: ( ) ___________________

Summit Christian Church Involvement


Do you attend Summit Worship services? __Yes __ No How long? _______
Are you a member of Summit? __ Yes __ No How long? _______
If not a member, where is your membership? ________________________________
Have you served in a ministry at Summit? __ Yes __ No
Which ministries? ___________________________________How
long?_____________________________________
Do you attend an Adult Bible Fellowship class at Summit? __ Yes __ No
If so, which class?
____________________________________________________________________________
What ministries/organizations outside of Summit are you involved in?
____________________________________________________________________________
____________________________________________________________________________
How did you hear about this mission trip? _____ Summit_____Friend _____ Website _____ Bulletin
_____ ABF Class _____ Information Center _____ Other
Explain:_________________________________________________________
Return pages 4-10 to Missions & Outreach Ministry
Occupation
Please describe your present employment and any pertinent information regarding work experience related
to missions.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Language Fluency
(Other than English — Conversation: Fluent, Fair, Poor)
Language Number of Years Conversational Fluency
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Skills & Talents


Please write the appropriate CODE next to your skills/talents.
CODES: A= Average G = Better than average P = Professional
I. CONSTRUCTION V. MEDICAL
______ A. Carpentry ______ A. Nursing
______ B. Painting ______ B. Physician
______ C. Masonry/Carpentry ______ C. Dental
______ D. Roofing ______ D. E.M.T.
______ E. Electrical ______ E. C.P.R.
______ F. Plumbing ______ F. Therapy (P.T.; O.T.; other)
______ G. Other ____________ ______ G. Other ________________

II. BUSINESS VI. MUSIC


______ A. Computers ______ A. Instrument (please list)_____________
______ B. Accounting ______ B. Vocal ____________
______ C. Other ____________ ______ C. Other ____________

III. SPORTS VII. OTHER PERFORMANCE


______ A. Basketball ______ A. Juggling
______ B. Baseball ______ B. Clowning
______ C. Soccer ______ C. Puppetry
______ D. Softball ______ D. Other ____________
What position do you play? _____________________
Coaching experience? __________________________

IV. MINISTRY EXPERIENCE


______ A. Teaching Ages:_____
______ B. V.B.S.
______ C. Crafts
(not all of these areas may be offered on all trips)
Personality Profile
1. Have you completed a Spiritual Gifts Class? If so, what are your top three gifts?
__________________________ __________________________ __________________________
2. Describe how OTHERS view your personality:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3. Describe your personal STRENGTHS:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
4. Describe your personal WEAKNESSES:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. Are you comfortable sharing your faith with others? _____ Yes _____ No
6. How would you describe yourself: ___ introvert ___ extrovert ___ intuitive
___ fact oriented ___ feeling —– thinking
___ perceptive ___ decisive

Mission Experience
Outline the mission trips you have taken, if applicable. Include how long you were on each trip, where
you went, and what impact each trip had on your life.
Trip Name: __________________________________________________________________________
Trip Dates/Year: ______________________________________________________________________
Lessons Learned: ______________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Trip Name: __________________________________________________________________________


Trip Dates/Year: ______________________________________________________________________
Lessons Learned: ______________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
My Personal Relationship with Jesus Christ & Mission Goals
1. When did you become a Christian?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
2. Describe your personal relationship with Jesus Christ.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________
3. Why would you like to participate in this trip?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
4. What would make this mission trip a success for you?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. Have you spoken to your family (parents/ spouse/ children) regarding this trip?
____ Yes ____ No
6. How was their response to your decision to go on this trip?
____ enthusiastic ____ skeptical ____ negative ____ supportive
7. Do you have any questions or concerns regarding this short-term mission trip?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Character References
Name:________________________________________________________________________
Address:_______________________________________________________________________
Phone: ________________________________ Relationship: ____________________________

Name:________________________________________________________________________
Address:_______________________________________________________________________
Phone: ________________________________ Relationship: ____________________________

Name:________________________________________________________________________
Address:_______________________________________________________________________
Phone: ________________________________ Relationship: ____________________________

Please include friends, co-workers, etc. No relatives please.


I understand and agree to the following policies:

• I have included my $100 deposit that is due with this application and I understand
that the deposit and all contributions are not refundable.
• I have read and accept the “Policies and Procedures” and “Consider the Cost of
Short-term Missions.”
• If I cancel, I will responsible for full payment of any costs incurred my behalf in
preparation for the trip.
• I have read and signed the Team Covenant. I will adhere to the Team Covenant if
accepted to the Short-Term Mission Team.
• I commit to attending and participating in the mandatory meeting(s) for the trip(s)
that I’ve applied for.
____________________________________________ _________________
Signature Date
Short-Term Missions Medical Information & Release
This form must be filled out in order for you to participate in a Short-Term Mission Trip with Summit
Christian Church.

Name: ________________________________________________________
Birth Date: _______________________
Address: __________________________________________________________________________
City: _____________________________________ State: ____________ ZIP:__________________
Home Phone: ( ) ______________________ Work Phone: ( ) ______________________
Medical Insurance Provider:
___________________________________________________________
ID # _______________________________ Group # __________________________________
Will your medical insurance cover you out of the country? _____ Yes _____ No
Name of Primary Physician:
___________________________________________________________
Address:
___________________________________________________________________________
City: ________________________________ State: ____________ ZIP: __________________
Phone: ( ) ____________________________
Emergency Local Contact: ___________________ Relationship: _______________________
Address: __________________________________________________________________________
City: ________________________________ State: ____________ ZIP: __________________
Home Phone: ( ) ______________________ Work Phone: ( ) _____________________
Please check if you suffer from any of the following medical conditions
__ Hypertension __ Hypoglycemia __ Bleeding Disorders __ Heart Disease __ Seizures
__ Insect Allergies __ Asthma __ Chronic Anxiety __ Arthritis __ Diabetes __ Depression
__ Glaucoma __ Migraines
Physical limitations – Please list:
______________________________________________________________________________
List any medications (prescription or OTC) taken on a regular basis:
______________________________________________________________________________
______________________________________________________________________________
List Medical & Food Allergies:
______________________________________________________________________________
______________________________________________________________________________
Blood Type: ___________ Have you had any surgery in the past three years: __ Yes __No
If so, please explain:
_________________________________________________________________
In an emergency, I give my permission to a licensed physician to hospitalize or anesthetize me, or perform surgery on me. I
understand that every effort will be made to inform my emergency contact before these actions are taken.
Signature: ____________________________________________________Date: ______________________

Parent/Guardian Signature: ______________________________________ Date: ______________________


(only if participant is under 18 years of age)
Relationship to Participant:____________________________________

Summit Christian Church


Statement of Faith

Summit Christian Church is an independent, nondenominational fellowship. Since our founding in


1999, we consistently have tried to be a church where Christians from diverse backgrounds can
worship freely together. We have laid aside the differences of our background to unite through the
love of Jesus Christ, and to serve together to help build His kingdom. With this in mind, we have
established the following abbreviated statements which summarizes our beliefs. The leadership and
pastors at Summit are united in their agreement upon these points. This is what we believe, and this is
what we teach:

God: God is the one and only Sovereign Creator. God is a spiritual being. He is holy (without sin),
all knowing, all powerful, everywhere present, and eternally existent. (Exodus 3:14-15; Timothy 6:15-
16; Isaiah 40:13-14; John 4:24; Psalm 90:1-6) God the Father, God the Son, and God the Holy Spirit
are distinct personalities with distinct roles, but one God. (Matthew 28:19; John 1:1-2, 10:30, 14:7-10,
25-26; Colossians 1:15-19; Hebrews 1:1-4)

Jesus Christ: Jesus became “God in the flesh”. He existed in the beginning with God, and was God.
He then was born a man through the miracle of the virgin birth by the power of the Holy Spirit.
Despite temptation, He lived a sinless life. (Matthew 1:18-25; Luke 1:26-45; John1:1-2, 14; Hebrews
4:14-15)

Jesus was crucified and died a physical death as an atonement for the sins of mankind. He experienced
a physical resurrection from the grave. (Luke 23:23-23, 53; I Corinthians 15:3-8; I John 2:2)

Jesus came in the flesh as our Savior; He will return in the future in bodily form as the victorious Lord
of the Universe. At the time, He will gather together His followers and will pass judgment upon those
who have rejected Him. (Mark 13:32-37; Acts 1:9-11; Titus 2:13; Hebrews 9:27-28)

The Holy Spirit: The Holy Spirit lives within those who believe in Jesus Christ. He is our Comforter,
our Advocate, and He helps us to become more like Jesus in thought, word, deed, and character.
(Galatians 2:20-21; John 14:15-17, 16:5-15)

Mankind, Sin, and Salvation: Men and women were created in the image of God, but are now
separated from God by sin. (Isaiah 64:6-7; Romans 3:23, 5:12-21, 6:23; I John 1:8)

Faith (belief, trust) in Jesus – based on His sacrifice on the cross – is the only way for men and women
to be reconciled to God (John14:6; Acts 4:8-12; Romans 3:25-26)

Salvation, offered through Jesus is based upon grace, not merit. Salvation therefore cannot be earned;
it is a gift from God. What we could not do for ourselves (reconcile our relationship with God), Jesus
did this for us through His death on the cross. (Ephesians 2:8-9)

God lovingly offers salvation to every person; every person has the freedom to accept or reject this gift
from God at any time. (John 3:16-18; I Timothy 2:3-4; II Peter 3:9)
Faith (belief, trust in Jesus requires repentance (conforming our lifestyles to that of Christ. Faith in
Jesus results in obedience. Baptism by immersion demonstrates our response to God’s offer of
salvation as a pledge of willingness to live for Him. (Acts 3:19; 2:38, 8:26-38; Romans 6:1-4; I Peter
3:21)

The Bible: We believe the Bible is inspired by God and is therefore without error or contradiction,
and is the sole authority for faith and practice. All our beliefs come from the Bible. (II Timothy 3:15-
16; II Peter 3:15-16; John 17:17)

The Church: The Church of Jesus Christ is no limited to anyone institution or denomination; it
consists of all who have placed their trust in Jesus Christ to provide redemption for their sins. Summit
therefore is but one part of the total Church (I Corinthians 12:12-17; Ephesians 4:4-6)

I have read the Statement of Faith and agree with it’s doctrine. I have accepted Christ as my Lord and
Savior.

Signature .

Date .

Adult Release and Indemnification Agreement


In consideration of the undersigned’s application for participation in a mission trip sponsored by Summit
Christian Church of Sparks, Nevada, Inc. (the “Church”) and as an inducement to organizing the mission trip
and permitting the undersigned’s participation agrees as follows:
The undersigned hereby fully and forever releases and waives and agrees not to cause to be brought any and all
claims, demands, actions, or causes of action of every possible kind and nature whatsoever the undersigned
might assert, including, without limitation, claims for personal injury, wrongful death, or property damage,
whether or not absolute, now or unknown, or otherwise against the Church or any of its trustees, elders, officers,
employees, agents and volunteers (collectively referred to herein as the “Releasees”) by reason of, arising out of
or relating to the undersigned’s participation in a church mission trip. The undersigned further agrees to
indemnify, defend and hold the Releasees harmless from damages, including, without limitation, special,
incidental and consequential damages, losses or expenses suffered or paid, directly or indirectly, as a result of
any and all claims, causes of actions, suits, proceedings, demands, judgments, assessments, and liabilities,
including reasonable attorneys’ fees incurred in litigation or otherwise, assessed, incurred or sustained by or
against the Releasees by reason of, arising out of or relating to the undersigned’s participation in a Church
mission trip. The undersigned further agrees that this Release and Indemnification Agreement (the
“Agreement”) is binding upon the undersigned’s
heirs, executors, administrators, assigns and legal representatives; that this Agreement releases all successors,
assigns and legal representatives of the Releasees; and that this Agreement is to be governed by the law of the
State of Nevada.

The undersigned further agrees that the execution of this Agreement is continuing in nature; it is the
undersigned’s knowing and voluntary act; the undersigned does not intend to participate in the mission trip until
and unless the undersigned has had full opportunity to the undersigned’s satisfactions to inspect and determine
the scope of the mission trip and receive all information from the leader or Church Mission Ministry which bear
on the undersigned’s decision to participate; and the undersigned is under no duress or undue influence to
execute this Agreement.

The undersigned hereby grants full permission to the Church to use any photographs, videotapes, motion
pictures, recordings, or other records or documents of the mission trip and to do so without notice or
compensation to the undersigned. The undersigned acknowledges that the Church has made available
applications for travel insurance and agrees that it is the undersigned’s responsibility to purchase travel
insurance. The undersigned assumes responsibility for full payment of the published and announced cost of the
mission trip; agrees to pay any outstanding balance upon request by the Church; and agrees
that any and all cost incurred by the undersigned during the mission trip, including, without limitation, costs due
to health problems, emergencies and death, are the responsibility of the undersigned or estate of the
undersigned.

The undersigned certifies that the information provided in the undersigned’s application for participation in the
Church mission trip is true, complete and correct and acknowledges that the undersigned has read and
understands this Agreement; that the undersigned has not relied in signing this agreement on any statement, oral
or otherwise, by the Church; and that it is the undersigned’s intention with this Agreement to make a complete,
general and unconditional release of any and all claims whatsoever against the Releasees as set forth above.

IN WITNESS WHEREOF, the undersigned hereby executes this Agreement on the date set forth below.
Date: _______________________
Signature: ________________________________________________
Printed Name: _____________________________________________
Youth Release and Indemnification Agreement
The undersigned enters into this Agreement as the parent or legal guardian of the below-named minor:
__________________________________________.

In consideration of the undersigned’s application for participation in a mission trip sponsored by Summit
Christian Church of Sparks, Nevada, Inc. (the “Church”) and as an inducement to organizing the mission trip
and permitting the undersigned’s participation agrees as follows:

The undersigned hereby fully and forever releases and waives and agrees not to cause to be brought any and all
claims, demands, actions, or causes of action of every possible kind and nature whatsoever the undersigned
might assert, including, without limitation, claims for personal injury, wrongful death, or property damage,
whether or not absolute, now or unknown, or otherwise against the Church or any of its trustees, elders, officers,
employees, agents and volunteers (collectively referred to herein as the “Releasees”) by reason of, arising out of
or relating to the undersigned’s participation in a church mission trip. The undersigned further agrees to
indemnify, defend and hold the Releasees harmless from damages, including, without limitation, special,
incidental and consequential damages, losses or expenses suffered or paid, directly or indirectly, as a result of
any and all claims, causes of actions, suits, proceedings, demands, judgments, assessments, and liabilities,
including reasonable attorneys’ fees incurred in litigation or otherwise, assessed, incurred or sustained by or
against the Releasees by reason of, arising out of or relating to the undersigned’s participation in a Church
mission trip. The undersigned further agrees that this Release and Indemnification Agreement (the
“Agreement”) is binding upon the undersigned’s heirs, executors, administrators, assigns and legal
representatives; that this Agreement releases all successors, assigns and legal representatives of the Releasees;
and that this Agreement is to be governed by the law of the State of Nevada.

The undersigned further agrees that the execution of this Agreement is continuing in nature; it is the
undersigned’s knowing and voluntary act; the undersigned does not intend to participate in the mission trip until
and unless the undersigned has had full opportunity to the undersigned’s satisfactions to inspect and determine
the scope of the mission trip and receive all information from the leader or Church Mission Ministry which bear
on the undersigned’s decision to participate; and the undersigned is under no duress or undue influence to
execute this Agreement.

The undersigned hereby grants full permission to the Church to use any photographs, videotapes, motion
pictures, recordings, or other records or documents of the mission trip and to do so without notice or
compensation to the undersigned. The undersigned acknowledges that the Church has made available
applications for travel insurance and agrees that it is the undersigned’s responsibility to purchase travel
insurance. The undersigned assumes responsibility for full payment of the published and announced cost of the
mission trip; agrees to pay any outstanding balance upon request by the Church; and agrees that any and all cost
incurred by the undersigned during the mission trip, including, without limitation, coasts due to
health problems, emergencies and death, are the responsibility of the undersigned or estate of the undersigned.

The undersigned certifies that the information provided in the undersigned’s application for participation in the
Church mission trip is true, complete and correct and acknowledges that the undersigned has read and
understands this Agreement; that the undersigned has not relied in signing this agreement on any statement, oral
or otherwise, by the Church; and that it is the undersigned’s intention with this Agreement to make a complete,
general and unconditional release of any and all claims whatsoever against the Releasees as set forth above.

IN WITNESS WHEREOF, the undersigned hereby executes this Agreement on the date set forth below.
Date: _______________________
Parent or Legal Guardian: ____________________________________
Signature: ________________________________________________
Printed Name: _____________________________________________
Short Term Missions

Application Check List

Name .

Trip Location .

Phone Number (H) . (C) .

1. . Applications complete
2. . Policies and Procedures explained and signed
3. . Team Covenant signed
4. . Medical Release completed
5. . Statement of Faith signed
6. . Adult/Youth Release signed
7. . Team Covenant signed
8. . Interview date with
9. . Deposit paid date check cash