Mission Trip ApplicationPrevious Team Members Click here for information about our upcoming mission trips Mission Trip Application - Previous Team Members **Note***All information in this application will be kept confidential and disclosed only to those who need to know in order to fulfill their responsibilities at Lynn Haven United Methodist Church Name (Full name as it appears on your passport)* First Middle Last Which Mission Trip(s) are you interested in? Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Email* Phone*Do you have a valid passport?* Yes No Passport #: Passport Expiration Date: MM slash DD slash YYYY SPIRITUAL INFORMATIONAre you currently attending Lynn Haven UMC?* Yes No If not, which church do you attend? How often do you attend church services/events?* What church ministries are you involved in?*Do you attend a home small group/Bible study or Sunday school class? When/where?*List two people who know you and where you are on spiritual walk (name and email): HEALTH INFORMATIONSelect any health conditions you currently have or have previously experienced. Use CTRL button to select multiple responses, if needed.Fainting SpellsEating DisorderHeart ProblemsDiabetesRespiratory ProblemsMigrainesSeizuresList any conditions not selected above and list all medications you currently take:PERSONAL INFORMATIONWhat are the most significant events that have occurred in your life in the past two years?*AGREEMENT/SIGNATURELynn Haven United Methodist Church requires compliance with rules and regulations, including the rules concerning conduct, dress and Christian lifestyle. These will be explained in the Team Covenant, which will be provided to accepted team members. The goal of this team is not to be perfect but to exemplify the kind of unity and servant hood found in Philippians 2:1-7 as well as grow in relationship with Jesus Christ. I agree to submit to the team leadership and abide by specific team expectations (i.e.: attending all team meetings, participating in team and individual fundraising, etc.) based on our role as servants of Christ and the cultural sensitivities of the host country. I understand that failure to conduct myself in an appropriate manner could result in my dismissal from the team, requiring me (or parents if under 18) to purchase airfare back to the US at my own expense. I understand that if accepted for this trip, I will participate voluntarily; I am completely responsible for my own health, safety and conduct while on this trip. I will not hold Lynn Haven UMC (LHUMC), its employees or the leaders of this trip responsible for any accident, injury, illness or loss of any kind which might result directly or indirectly from my participation in said trip, and hereby release and indemnify LHUMC, its employees and the leaders of this trip from any such accident, injury, illness or loss. I understand that my signing below indicates my understanding and agreement with the information in this application. I affirm that all the information in this application is correct to the best of my knowledge and I give permission for LHUMC mission staff or representatives to verify the information I have given and contact the people I listed as references. A $100 non-refundable deposit is required upon approval of your application. Consent I agree to the expectations as outlined above.Digital Signature of Applicant (Signature of Parent/Guardian if Applicant is Under age 18)* Date MM slash DD slash YYYY Parental Permission Form for Team Members under 18 Years of AgeName of Parent/Guardian Completing Form First Last In case of accident, illness, or injury, I hereby give my permission for medical attention to be given to: Required Agreements I will not hold LHUMC, its employees or the leaders of this trip responsible for any accident, injury, illness or loss of any kind which might result directly or indirectly from participation in said trip and hereby release and indemnify LHUMC its employees and the leaders of this from any such accident, injury, illness or loss I hereby request the leaders of this trip to carry out any discipline deemed necessary for my child. I also agree, if necessary, to pay the cost of my child’s being sent home as a result of disciplinary action. Digital Signature of Youth Team Member Date MM slash DD slash YYYY Digital Signature of Parent/Guardian of Youth Team Member Date MM slash DD slash YYYY
