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Application
   

    
   
MISSIONS APPLICATION: SHORT-TERM TRIP
Completed application and pastor’s recommendation must be received no later than six (6) weeks prior to the scheduled dates of the trip.

Please Staple
Wallet Size
Photo Here

Please complete this application, scan and e-mail to:

Bring the original completed form with you to the first team meeting.

Date of outreach:

NAME OF TEAM MEMBER (as it appears on your passport)
Last
First Middle
Team/Group Name:
Team Leader:
Phone Number:
Email Address:

I. Contact information
Mailing address (If student, please list both school and home/ permanent address) Home / Permanent address

Home

Work

School (if attending college)

E-mail

Telephone

Cell





Mailing address (If student, please list both school and home/ permanent address) Home / Permanent address
Street Address or P.O. Box

School address

II. Personal Information
Name / nickname you prefer to be called

Age                               Male Female

Marital Status: Single/Married

Spouse’s Name


III.        Personal Identification information

Passport Number                  Date of Issuance                  Date of Expiration              
                                                                 (mm/dd/yyyy)         (mm/dd/yyyy)

Place of Birth                            Citizenship                   Birth Date                      
                                                                                                           (mm/dd/yyyy)        
     
VI.    Emergency Information Name of emergency contact Street Address P.O. Box Day Time Telephone (Area Code)

Relationship to you     
    
City

State

Zip

Phone Phone Evening

V. Medical Information

Note: The following information will not necessarily prevent you from volunteering with Homes of Life, but it will be to your benefit for leadership to be aware of your medical history.
Have you ever had or been treated by a doctor for any of the following health problems:
Yes/No
_______Diabetes
_______Seizures
_______Fainting spell
_______Eating disorder
_______Respiratory problems
_______Psychiatric care
_______Depression
_______Asthma or chronic wheezing
_______Chronic persistent cough or shortness of breath
_______Tuberculosis
_______Any skin disorder or disease other than acne
_______Chronic or recurrent ear or eye problems
_______Impairment of hearing or vision. Cataracts or glaucoma
_______Persistent, recurring indigestion, stomach or duodenal ulcers
_______Gall bladder stones or colic
_______Jaundice, cirrhosis or other liver problems
_______Intestinal or bowel problems, colitis, hemorrhoids, other rectal problems or bleeding
_______Any test results indicating exposure to the AIDS virus
_______Kidney problems
_______Rheumatism, arthritis, or other forms of swollen painful joints
_______Serious bodily injury
_______Chronic back pain, back injury or surgery
_______Cancer
_______High blood pressure, heart murmurs or other cardiac problems
_______Sever migraine headaches
_______Anemia or other blood disorder
_______Severe allergic reactions to either food, medicines, bee stings or any other insect bite/sting
_______Treated for alcohol or drugs
_______Unusually sensitive to heat
_______Physical disability
_______Other allergies
_______Other_________________________________________________

If yes, please explain. (On seperate sheet and attach.)

Are you now taking, or will you be taking any medications   (circle)       No        Yes

List Medications/Dose/Condition







VI. Christian Service

Home Church

Name of Pastor

Email:

Address/City/State/Zip

Phone

How often do you attend church?


Describe your involvement in your church and Christian service
What do you desire to gain from participating in a mission’s trip?
How do you desire to benefit those you serve?


Please describe: (In approximately 150 words each) Use separate sheet of paper.
1. When and how you came into a personal relationship with Jesus Christ as your Savior and Lord:


2. Your current relationship with God, including how you are seeking to share Christ with others now:


VII. Experience
Employment: Part-time  Full-time  Retired  Student  Military

Level of education you have completed

Describe your present employment or type of education

Have you ever traveled overseas?   No/Yes

If yes, where and when

Do you speak any foreign languages? No/Yes

If yes, indicate language and proficiency level

What experience do you have working with other cultures?

Have you ever been on a mission’s trip before? No/Yes

If yes, where and when

Within the past year, have you been involved with Tobacco?

Have you ever Served time in a detention center or jail Been convicted of committing a crime?

No to all of the above. If yes to any of the above, please explain:(On seperate sheet and attach.)




Have you ever been involved with a cult or the occult? No/Yes
If yes, please explain.(On seperate sheet and attach.)


Of the activities listed below, check those in which you have training, expertise or experience:

_______working with preschoolers
_______working with pre teens / teens
_______household cleaning
_______electrical
_______plastering
_______auto mechanics
_______music/singing
_______simple carpentry
_______door-to-door outreach
_______Vacation Bible School
_______Painting Plumbing
_______raking leaves
_______Teaching
_______cooking meals
_______Sewing
_______Drama
_______speaking to groups
_______mixingcement
_______ construction – general
_______Masonry
_______puppets/clowning
_______hanging and folding laundry
_______computers (networking/tech)


For the items checked, please provide any detail you think might be helpful(On seperate sheet and attach.)

Describe three of your positive aspects or strengths



Describe three of your weaknesses




VIII. Additional Information
Include any other information about yourself that you feel would be helpful:(On seperate sheet and attach.)





 WORKING WITH NATIONALS OVERSEAS & LOCAL
Because you are traveling to a foreign country or local tribe with a different culture, we have stringent policies that our short-term ministry partners follow while they are overseas. We do this for the safety of our ministry partners and in respect of the leaders. All ministry partners are under the supervision and direction of the team leader and leadership of the local ministry where they will be serving. Our ministry partners need to understand that they will be expected to work the same or similar schedule as the national workers, and may be sharing meals and devotionals with the local staff. Time off and leaving the site of the ministry must be cleared with the team leader and the local ministry leader. Because of differences in cultures and communication, dating while on a mission trip is strictly prohibited. Unmarried couples, even those engaged, are to refrain from all forms of physical contact, including hand holding, hugging, kissing and sitting on laps both in public and in private. Please remember, we send ministry partners to serve as representatives of Christ.
Your signature below states acknowledgment, agreement, and adherence to the Nets of Arukah Ministries overseas & local policies, without exception.
Participant Signature                                                          
Date




ALCOHOL, DRUG & TOBACCO POLICY
Because of cultural perceptions and possible stumbling blocks which could result, the Nets of Arukah Ministries has a stringent policy against the use of tobacco or consumption of alcoholic beverages of any kind en-route and/or on the field.
My signature below states acknowledgment, agreement and adherence to the Nets of Arukah Ministries tobacco and alcohol policy without exception.
Participant Signature
 Date



RELEASE AND INDEMNIFICATION AGREEMENT
I, the undersigned (and we the parents or legal guardians and/or custodians of the undersigned if a minor or under legal disability) in consideration of the services and sponsorship of the Nets of Arukah Ministries and local (in-country) ministry hosts, (hereinafter referred to as HOSTS) and other valuable consideration, and permission of HOSTS for me to go on a short term mission project under its auspices, HEREBY RELEASE AND AGREE TO HOLD HARMLESS all HOSTS and its officers, employees, agents and servants, from any liability whatsoever, as the result, whether immediate or proximate or not, of my participation in the short-term mission trip sponsored by the HOSTS; and I specifically agree to personally provide any and all insurance policy protection. I totally agree that members serve at their own risk and the HOSTS are not liable in the event of sickness, accident, death, terrorist acts, transportation or any other expenses beyond that of normal involvement.
I also hereby acknowledge that the information I have given the HOSTS is accurate and true to the best of my knowledge. I understand that any team member who is over the age of 18 will possibly be subject to a background check. My signature below will give the HOSTS authority to obtain any files or records needed in order to conduct such a background check. I hereby waive all rights or claims to privacy in relation to this background check. This check only applies to criminal files and only for the period leading up to the trip.
I also give the HOSTS the right to use my picture, voice and/or testimony in any form for promotional or advertising materials. My enclosed signature (and signature of my parent or legal guardian, because I am under the age of 18) signifies my approval of all limitations listed above.
Name of Participant (printed)
Signature

Date                            Month/Date/Year


Name of Guardian (printed)

Signature

Date                        Month/Date/Year





CASH DONATIONS AND GIFT POLICY
I agree to communicate directly with the missionaries in charge about any desire to bless them or any child or worker that is affiliated with the ministry that I am serving at. I agree that any gift given overseas is not tax deductible and to get a tax receipt it must be run through my local church or through our partner ministry. I do choose to obey and follow policy listed above. If I want a tax receipt I will send specific contributions and/or gifts to the Nets of Arukah Ministries with instructions designating my gift to the appropriate cause I wish to support.
Participant Signature Date

REFUND POLICY
To receive a tax deduction, the IRS stipulates that the donor must release control of the funds donated to the non-profit organization. For this reason, donations cannot be designated for an individual's personal use. Each participant who raises funds will be given credit for the funds raised. The funds received are not refundable. If an individual is unable to participate in the Nets of Arukah Ministries outreach experience, the funds he/she has raised, less incurred expenses and administrative fees, will remain credited to his/her account for up to one year. Credit for the funds received may be transferred to a Nets of Arukah Ministries project or missionaries or other applicant of his/her choice only by written request.
Participant Signature                                                        Date
Parent /Guardian Signature                                                   Date

TRAVELERS INSURANCE
The Nets of Arukah Ministries requires that each team member acquires Traveler’s Insurance. Usually the Nets of Arukah Ministries secures the policy for all team members and the premium is included in the total cost for the trip.
Insurance Company ________________________________
Policy Number: __________________________________
Effective Dates ____________________________________
Participant Signature                                                         Date
Parent /Guardian Signature                                                   Date


IX. References

SHORT-TERM
PASTOR’S RECOMMENDATION :
Please complete this form, scan and email directly to: [email protected] Dear Pastor:
    
Completed pastor’s recommendation must be received no later than six (6) weeks prior to the scheduled dates of the trip.
        
is applying to serve as a short-term missionary with Nets of Arukah Ministries
As a Christian, Bible based ministry, we take great care to provide the safest and most loving home environment possible for our very vulnerable population of children and/or adults. With this in mind, please complete the following form and return it to the above email address at your earliest convenience.
Thank you and blessings, Nets of Arukah Leadership!
PASTOR’S RECOMMENDATION
I have read this application, and to the best of my knowledge all of the information is complete and accurate. Based upon my personal knowledge of the applicant over the past ______________(years/months). I give the following recommendation for their participation on a trip with the Nets of Arukah Ministries.
_______Strongly Recommend
_______Recommend
_______Recommend with Reservation
_______Do Not Recommend
(If you do not strongly recommend please explain on a separate piece of paper and attach to this form.)


Do you believe the applicant will be able to submit to authority and adapt to a new culture?
_______Strongly
_______Agree
_______Agree Have Reservations
If there is any other information not included on this application you feel we should be aware of, or if you have any additional comments concerning the applicant, please describe in the space below.

Name (printed)

Position

Signature                                                                 Date

Please in your own words provide us with your thoughts on the character and personal nature of the applicant. We are looking to see if there are any issues prior to the trip to avoid conflict or by putting someone in a position they are not ready for. 


PERSONAL:
Please list three people who have known you at least 1 year and are not a relative.


I  give the Nets of Arukah Ministries team permission to contact the references I have provided to collect information on me to make a determination on the trip I have applied for. In doing so I do not hold Nets of Arukah Ministries responsible for the outcome provide and determination made.
Signature                                                                Date