Mission Trip ApplicationIs God calling you? Click here for information about our upcoming mission trips If you are a previous team member, please click here to complete the trip application Mission Trip Application **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* 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 AfghanistanÅland IslandsAlbaniaAlgeriaAmerican 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 RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican 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 RicoQatarRéunionRomaniaRussiaRwandaSaint 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 IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Email* Phone*Birth Date* Date Format: MM slash DD slash YYYY Gender*MaleFemaleNicknameDo you have a valid passport?*YesNoPassport #:Passport Expiration Date: Date Format: MM slash DD slash YYYY SPIRITUAL INFORMATIONIs Lynn Haven United Methodist your home church?*YesNoHow often do you attend LHUMC services/events?*Are you a member of LHUMC?*YesNoIf not, are you a member of another church? Provide name of church and pastor's name.What church ministries are you involved in?*Do you know your spiritual gifts? If yes, what are they? If no, what do you think they are?*List three people within LHUMC (pastors and/or lay leaders) who could give you a reference. Include phone numbers for each.*List one person who knows you and where you are on spiritual walk (name and phone #):Please describe how and when you came to know the Lord:*Have you ever served on a mission trip, or had any cross-cultural experience? If yes, where and when? Explain.*Please explain briefly why you want to participate in this trip?*WORK EXPERIENCE/TALENTSPlease list any specific talents that you have. (drama, singing, instruments, puppets, construction, medical, teaching, etc.)*Are you employed?*Yes, full-timeYes, part-timeNoEmployer Name:Length of employment at current organization:Do you speak any foreign languages fluently?*YesNoLanguage(s) spoken:What do you see as your strongest character quality and why?*What do you see as your weakest character quality and why?*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 ProblemsMigrainesSeizuresDo you have any condition which might affect your ability to fully function on this trip (i.e., fear of flying, depression, anxiety, sleeping disorders)?*YesNoIf yes, Explain:Do you have any chronic illnesses or allergies?*YesNoIf yes, Explain:Are you presently under medication prescribed by a doctor?*YesNoIf yes, Explain:List any conditions not selected above and list all medications you currently take:Does your health insurance cover you overseas?*YesNoHow would you describe your health and fitness?*ExcellentGoodAverageNeeds workHave your received the standard US vaccinations?*YesNoDo you have any personal objections to obtaining required vaccinations for this trip? If yes, explain.*PERSONAL INFORMATIONWhat are your personal expectations for this trip?*How does your family feel about you going on this trip?*Have you ever been convicted of committing a crime?*YesNoIf yes, Explain:If you are applying for a trip that includes ministry to children, you may be required to have a background check. Will you agree to a check?*YesNoWhat 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 Date Format: 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 AgreementsI 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 lossI 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 MemberDate Date Format: MM slash DD slash YYYY Digital Signature of Parent/Guardian of Youth Team MemberDate Date Format: MM slash DD slash YYYY Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.