Mission Trip 2017

Application
CHECKLIST:
Application
Questionnaire (there are 2. Make sure you do the correct one.)
Schedule Interview with Jenna
Code of Conduct
Parent Conduct Agreement (1 required from each parent)
Financial Memo
Medical Release
Copy of Insurance Card
Signature of Experience Training
Non-Refundable Deposit of $50

IMPORTANT DATES:
March 1st, March 5th Mission Trip Launch Parties
March 1st 6:30pm at St Luke UMC
March 5th 3:00pm at Davis Memorial UMC
March 12th Last Day to Apply For Mission Trip
March 12th 23rd Interviews
March 24th 25th Spring Retreat (suggested for Mission Trip attendees)
April 2nd First Payment Due*
April 30th Mission Trip Parent Meeting
May 7th Final Payment Due*
May 14th Last Day to Pay (also Mothers Day)
May 20th Mission Trip Boot Camp 11am 4pm (required for 5 th grade, 6th
grade, and first timers. Suggested for all others.)
June 2nd -3rd Youth Lock-In at Davis Memorial UMC
June 5th 11th Mission Trip 2017!!!!
Mission Trip Application
Full Name: _______________________________________________
Preferred Name: ________________________________________
Date of Birth: __/___/___ Age (as of June17): ___ Grade 16-17 school year*: _______
Address: _____________________________________________________________
_____________________________________________________________
Phone Number: ___________________ Email: _____________________________
T-shirt (Adult) Size: XS S M L XL XXL 3XL 4XL Home Church: SLUMC DMUMC
SSN: _____________________________ Gender: ______________
Parent Name(s)*: _______________________________________________________
Parent Phone Numbers*:
__________________________________________________
Preferred Parent Email*: __________________________________________________
Number of Mission Trips I Have Attended: ______ Number CTCYM Trips: _______
In case of emergency, contact: ___________________________________
Phone: ________________ Email: _________________________
Are you able to:
1. Lift objects up to 50lbs Y N
2. Be on your feet for long periods of time Y N
3. Interact with people of different experiences Y N
4. Control your tongue Y N
5. Love people you dont know Y N
6. Refrain from judgement of others Y N
7. Refrain from arguments with others Y N
8. Behave yourself in public situations Y N
Additional Information:

Signed: _________________________ Parent Signature: _______________________

Date: ___________
Youth Questionnaire
Name: _____________________________ Grade 16-17: ________________
Number Previous Trips: ______ Birthdate: ___________ SLUMC DMUMC
1. Why do you want to go on this mission trip?

2. Do you consider yourself: a Christ-follower, learning about God/Jesus, unsure

about God/Jesus, atheist, or other? Why?

3. Have you been baptized? Confirmed?

4. What is the most important thing God has done in your life lately?

5. What do you want God to show you on this trip?

6. How can you show Gods love to others on this trip?

7. What fears/concerns do you have about mission trip?

(*make sure you fill out and turn-in page 2!)

On a scale of 1-10 (1 is not much, 10 is totally) how comfortable are you with:
Knowing everything about the Bible?
Praying out loud in front of a group?
Praying with someone 1 on 1?
Sharing about God with others?
Sharing about Jesus with others?
Leading a lesson or devotional?
Giving a sermon or testimony?
Singing in front of other people?
Listening to adults?
Leading adults?

What makes you a good candidate for this mission trip?

Other information for Jenna to consider:

Adult Questionnaire
Name:__________________________________ Previous Trips: __________
SLUMC or DMUMC Names of Children in SLeD Youth: _________________________
1. Why do you want to attend this mission trip?

2. How has God impacted your life in the past year?

3. If you have a youth child, how have THEY been impacted by God this past year?

4. What do you hope God will do this year during the mission trip?

5. What about pre-teens and teens inspires you?

6. What do you hope to learn about God on this mission trip?

7. How do you want to contribute on this mission trip?

8. What fears or concerns do you have about this trip?

On a scale from 1-10 (1 being not at all, 10 being completely), how comfortable are you:
With your knowledge of the Bible?
With your relationship with God?
With your relationship with Jesus?
With leading lessons for youth?
With leading lessons for adults?
With praying aloud for youth?
With praying aloud for a mixed group?
Praying with someone one-on-one?
Working with people who suffer from mental illnesses?
Supporting a youth who is LGBTQ without judgement?
Working with LGBTQ adults without judgement?
Helping a youth who shares something deep with you?
Listening to and following the instructions of the youth director?
Listening to and following the instructions of a young adult?

Do you have any other questions or comments?

Covenant of Conduct
I am a representative of SLeD youth, St Luke UMC, Davis Memorial UMC, all pastors
and congregation members of both churches, Haltom City, North Richland Hills, and
of Gods love. As such, I will be an example of Christs love through my speech,
conduct, love, faith, and purity. I will not push my own personal agenda while on this
trip, but instead look for ways to be an example of Gods love.
SPEECH I will refrain from using profanity, sexually charged language, unkind tone
of voice, and racial or politically charged statements. I will use my speech to uplift
and to show compassion toward others. I will refrain from raising my voice or
getting in arguments with others.
CONDUCT I will behave in a manner appropriate for a disciple. I will not get in
physical altercations with others, threaten others, or be obstinate. I will participate,
be where I am supposed to be, and wear my nametag at all times. I will
communicate with Jenna if I am feeling unwell or off and have issues with something
going on. I will be respectful of everyone on this trip. I am allowed to have fun, but I
need to behave maturely as well. I will not participate in gang or drug related
activities while on this trip.
LOVE I will show compassion and acceptance for everyone I meet while on this
trip, regardless of whether or not I agree with their life choices. It is not my job to
judge anyone or to tell anyone how to live their lives. It is my job to share God with
others and to be supportive to my fellow mission trip attendees.
FAITH I will have faith that this trip will be amazing. I will search for God or Jesus in
every day and I work on my relationship with God during this trip. They may mean
searching for a deeper connection with God. For some it may mean just learning
more about God. I will have faith that I will be accepted for wherever I stand with
God, but I am asked to participate in all discussions, lessons, and worship times.
PURITY- I understand that mission trip is not a time for me to cultivate romantic
relationships. If I am in a relationship prior to the trip, I will behave in a mature
manner with my significant other. I will dress modestly. I will seek the purity within
my heart and ask God to make it grow.
The repercussions of breaking this covenant in part or whole may include
(depending on severity):
- private discussion with Jenna or my pastor
- being asked to not participate in certain fun activities
- being sent home from the trip at the cost and inconvenience of myself or my
parents
- being banned from future youth activities and mission trip
ADULTS ONLY: By signing this, I also agree that I have been through the 5 point
Ministry Safe process and that I will uphold the rules and regulations set in place by
those documents. I will not be alone with a youth at any point during this trip,
include those that are my own.
Signed: ____________________________________________
Parental Signature: ___________________________________________
Date: _______________________________________________________
PARENTS CODE OF CONDUCT
I understand that by sending my child on the SLeD Youth Mission
Trip, I am asked as their parent to uphold certain behaviors. If
going on the trip, I will adhere to the Covenant of Conduct as
signed. I also agree that:
1. On this trip, my child is just another youth. I will not give
them preferential treatment, and I will not hold them to a
higher standard than any other youth.
2. I will not force my child to hang out with me. If they cling to
me, I will encourage them to find someone else to hang out
with. I will respect my childs personal space and personal
growth during this trip.
3. I will let my child learn from their mistakes. I will not rescue
them if they forget something. I will allow them to face
consequences as set in place by the youth director if needed
and I will back up the youth director. If I have questions, I will
address them to the youth director or to the adults involved
in the issue.
4. I will not allow my child to have their phone. This will allow
my child to be fully engaged.
5. I will refrain from being on my phone for the majority of the
time. I will strive to be fully engaged and to leave my home
life at home so that I can fully connect with God.
If I am not attending the trip, I agree that:
1. I will refrain from contacting my child unless there is an
emergency. This trip is a chance for my child to connect with
God and with his or her youth group. I will respect their
chance to grow by not contacting them.
2. I will not allow my child to have their phone. If my child
needs to contact me, they can do so from an adults phone.
This will keep my child engaged in what is going on around
them.
3. I will let my child learn from their mistakes. I will not rescue
them if they forget something. I will allow them to face
consequences as set in place by the youth director if needed
 and I will back up the youth director. If I have questions, I
can address them to the youth director at an appropriate
time.
I will pray for my child, the other youth, and the adults on this
trip. I will pray for the people my child will interact with and those
whom my child will serve.
Signed: ____________________________________________________
Financial Memo
The entire cost of the trip is $265 per person. I realize that it is my and my familys responsibility
to raise or provide for 100% of the cost of my trip. This money will be applied to travel costs,
food, lodging, parking, activities, and work expenses. I am (or my family is) personally
responsible for 3 fast food meals, and 1 meal on the San Antonio Riverwalk as well as any
souvenirs, medical expenses incurred, anything I break, and any snacks I would like to have
during travel.
Fundraisers will be applied to youth accounts based on my participation in those fundraisers and
my attendance at church and youth. Adults are expected to raise their own funds in other ways.
If, for some reason, I am unable to participate in the trip, I am responsible for any fees incurred
as a result of my cancellation.
If I do not raise the full amount for my trip, I realize that I may not be able to go. Any money
raised and my $50 deposit will be applied to other participants. This money is used to pay for
expenses of the trip and cannot be refunded. (Only exception if I have paid my full amount out
of my own personal funds, I may be refunded up to $150).
If I raise excess funds, they will be applied to other trip participants. I am allowed to request they
be applied to a certain person. If all persons are covered, my excess funds will go toward the
2018 SLeD Mission Trips.
If inappropriate behavior and/or breaking the Covenant of Conduct or Ministry Safe agreements
or other policies causes me to leave the trip, I will not be refunded any amount of my trip. In this
circumstance, I and my family will be required to cover any expenses incurred due to my
expulsion from the trip.
I will return any unused money from my work day stipend (if any) to the mission coordinators at
the end of each work day along with all receipts. Mission Coordinators are required to give these
funds back to the finances of SLeD youth upon arrival home. If any amount of money is
unaccounted for, it will be my responsibility to cover it.
I have read and agreed to all above policies and terms.
Signature of participant: _____________________________ Date: _______________
If participant under 18, signature of parent: _________________________ Date: __________
Medical Release
Participants Full Legal Name: ____________________________________________________
Address: ______________________________________________________________________
City: ______________________________________ State: ______________ Zip:____________
Participant Phone Number: ___________________________ Birthdate: ___________________
In case of emergency, please notify:
Name: _____________________________________ Relationship: ______________________
Address: _____________________________________________________________________
City: _____________________________________ State: ______________ Zip: ___________
Phone Number: _________________________ Work Number: ______________________
Medical History:
General Health Issues: __________________________________________________________
Limitations: __________________________________________________________________
Do you have any of the following (if so, please circle):
Bad back Diabetes (specify type ___) Epilepsy Heart Disease Autism Spectrum
Hypertension Anxiety/Depression Asthma HIV/AIDS
Other: _______________________________________________________________________
Drug allergies: ________________________________________________________________
Food allergies: ________________________________________________________________
Date of last tetanus shot: ______________ Date of MMR shot: ________________________
Other important medical information: ______________________________________________
Current medications/dosages required on separate piece of paper with name of participant.
I hereby give permission for my son/daughter/self (if non-minor) to receive emergency
medical attention from a physician in the event of illness or injury. Circle One I hereby give
permission for my minor son/daughter to be given OTC medications such as Tylenol,
Aspirin, Mydol, Advil, Benadryl, Dramamine, Pepto Bismol, Immodium, etc. at the
discretion of the adults involved. Non minor if I am unable to make medical decisions for
myself, I give the youth minister and pastors permission to make medical decisions for me
until a next of kin can be contacted.
Parent or Non-Minor Participant Signature: __________________________Date: _______
Experience Training
Working with homeless persons and those in need can be quite the shock for a young
person. To help students be prepared for this, we will hold experience trainings on these
dates:

We require that each participant attend at least 1 of these trainings and get the
signatures of the persons in charge of the event. (see Mary Stauffer for details. 817-
832-0029). If you are unable to attend any of these trainings, we ask that you get in
contact with Mary Stauffer to discuss other ways to get experience in working with this
population prior to the trip. You will not be able to participate in the trip without this
documentation.

Name of Participant: _________________________________________________

Date of Experience Training: _____________
Person in charge name (printed): ______________________________________
Signature of Person in Charge: ________________________________________