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Mission Trip Registration

Malta 2019

Embark with us on this short-term mission trip to the island nation of Malta, where WorldVenture—an organization connected to many of our missionaries—is hosting their Spiritual Life Conference for all of their European, Middle Eastern, and Northern African based missionaries. They have asked Stonebriar to provide the childcare and programming for children ages birth to 12 years old. This will be a great time to provide these missionary families with some rest and relaxation.
12/26/2019 - 1/4/2020
$3,000.00

Additional Information

*Home Phone (If different from above):
*Cell Phone (If different from above):
Work Phone:
*Date of Birth:
*Gender:
*Citizenship:
If employed, where:
Occupation:
*Marital Status:
Spouse's Name:
Languages spoken and Degree of fluency:
*List your skills and hobbies:
*Have you traveled internationally before?
If so, list the place(s):
*Do you currently have a Certified Birth Certificate?
*Do you have a current Passport?
Full legal name as it appears on your passport:
Passport Number:
Passport Expiration Date:
Please provide the names of two references, whom we may contact.
*Reference 1 Full Name:
*Reference 1 Phone:
*Reference 1 E-mail:
*Reference 1 Relationship:
*Reference 2 Full Name:
*Reference 2 Phone:
*Reference 2 E-mail:
*Reference 2 Relationship:
*T-Shirt Size:
*Stonebriar Communitiy Church Affiliation:
*I have read the SCC Doctrinal Statement and agree to respect it in all regards and not propagate convictions not contained therein:
*What areas of the church have you been involved in? (i.e. Adult Fellowship, Project/Serve, Children, Student Ministries, Missions. Please list:
*What do you see God doing in your life right now?
*What has/is God teaching you about God and yourself?
*What lead you to consider this trip?
*Have you previously participated in short-term missions? If so, please list previous destinations and your role on those trips:
*What are your expectations for this trip? What would deem this trip a success in your mind?
*What are some of your concerns about joining this team?
*Describe a properly-functioning "team":
*What do you believe is the Biblical Purpose of global missions?
*What would you say to someone who wanted to know why they should become a Christian? (Include Scripture references when applicable.)
*What would you say to someone who wanted to know HOW they should become a Christian? (Include Scripture references when applicable.)
Health Information
*Height:
*Weight:
*Blood Type:
Emergency Contact Information
*Emergency Contact Name:
*Relationship to Emergency Contact:
*Emergency Contact Address:
*Emergency Contact Home Phone:
*Emergency Contact Cell Phone:
Emergency Contact Work Phone:
*Have you recently suffered a serious illness, had surgery, or been hospitalized?
If yes, please explain:
*Do you have any known allergies?
If yes, please explain:
*Do you have any dietary restrictions, food allergies, or convictions regarding types of food?
If yes, please explain
*Are you currently using any medications? (Including prescription and non-prescription drugs, dietary supplements, herbs, etc.)
If yes, please describe:
*Are you currently receiving medical treatment or under medical observation?
If yes, please explain:
*Have you ever been treated for (or are now suffering from) emotional difficulties? (i.e. eating disorders, depression, anxiety, phobias, etc.)
If yes, please explain:
*Do you have any other limitations or significant health conditions which might affect your involvement with missions or which you believe your physician would want us to know?
If yes, please explain:
*Do you have a communicable disease?
If yes, please explain:
*Do you have any chest, back, or joint pain?
If yes, please explain:
*Do you have any limitations to strenuous physical work?
If yes, please explain:
*Have you been exposed to the potential for the transmission of HIV/AIDS?
If yes, have you been tested?
If you have been tested, what were the results?
*Do you regularly use Tobacco, Alcohol or Other? If so, please explain:
*Physician's Name:
*Physician's Office Phone Number:

RISK STATEMENT

This Risk Statement is to advise you as a participant about the potential risks involved in working other cultures. Your signature certifies that you take full responsibility for the consequences as you assumes these risks. Risks can include hazards to both your person and property through cross-cultural offenses, accident, disease, criminal, terrorist acts, natural disasters or inadequate medical services and supplies. There can be added emotional and physical stress due to loneliness, culture stress, travel difficulties, and long hours. We realize that it is not possible for us to predict, or fully prepare you for every circumstance you will face. However, it is our goal to advise all members of SCC and all participants in SCC missions of the assumed risks associated with mission work in a foreign country and SCC’s policies, through this Risk Statement. We ask that you gather as much information as you feel necessary and, when you are completely satisfied and confident that participating in a short-term mission trip is what God wants you to do, read this form; if you agree, sign and return the application form. Keep a copy for your records. 

Stonebriar Community Church will not assign any member or participant to a particular ministry or area against their will. This means the final choice of ministry and area of service rests ultimately with you. Leadership may, in fellowship with you, give direction in areas of need and availability of programs but the final decision on service or participation in a program rests with you. Should you feel at any time that your area of service is no longer appropriate, you have full right to end your service and return to your passport country at your own cost and risk. 

In the event of an emergency that requires medical services while on the field, all reasonable efforts will be made to guide you to the appropriate care. If an evacuation is needed for more specialized care than is available in the designated area of ministry, that will be coordinated with and under the direction of the medical/evacuation insurance provider that is required for your participation in the SCC missions trip. You are required to adhere to the list of immunizations and vaccinations suggested before you travel to the country of ministry. Those lists can be found at https://wwwnc.cdc.gov/travel

Special Note: In view of the fact that many insurgent, guerrilla, and criminal groups commit crimes of kidnapping or other forms of criminal extortion as a means for demanding the payment of ransom, it is important that you understand SCC’s policy in this area. We are deeply concerned for the well being of each of our members, and will pray and labor diligently for the release of any member taken hostage. However, it is the policy that “SCC opposes the payment of ransom in any form, cash, commodities, or services.” Therefore, members and participants in SCC missions should not assume that ransom will be paid for their release. SCC requires that, as part of the post-crisis de-briefing, all members who were held hostage be interviewed by a counselor. 

LIABILITY WAIVER & RELEASE 
In consideration of being allowed to participate in the trip sponsored by SCC, its partners and/or agents and in consideration of the benefits to be derived there from, I hereby release SCC, its partners and/or agents and their present and former elders and employees, and their heirs, from all claims and liabilities of any kind, whether known or unknown, which arise from or are connected in any way with my participation or the participation of any member of my family including my spouse or minor child, in the SCC sponsored mission trip. I recognize that the conditions in some of the places to which I, my spouse, or my child will travel are not of the same standard as the conditions to which I am accustomed. I realize further that there are certain health risks as well as other risks to person and property, and I enter into participation in this trip and agree to the participation of my spouse or minor child with knowledge of those risks. If for any reason I am unable to complete the planned stay on the mission trip, I assume full responsibility for expenses incurred for my return home. 

In the event of an emergency, I hereby authorize a leader of this trip, as an agent for me, my spouse or my child to consent to: any x-ray examination; medical, dental or surgical diagnosis; anesthesia; treatments; hospital care advised and supervised by a physician, surgeon or dentist (as appropriate). I expect my family to be contacted as soon as possible. This is only for emergency situations should the individual be incapable of making rational decisions, or is a minor whose parents cannot be immediately reached. In any situation, every effort will be made immediately to reach the contact person listed on the application.

I agree that SCC, and my group may use and/or display my name and likeness without limitation for promotional purposes without further consideration. I authorize SCC, and my group, their partners and/or agents, permission to use, copy, reproduce, display, distribute, publish, and exhibit any pictures, video or narrative I take during the trip which I provide to any of them, and pictures, video or narrative in which I may be included, without restriction. This authorization includes any means of communication at any place for any lawful purpose. I waive any right I might have to inspect and/or approve the copy that may be used or the use to which it may be applied. 

I certify that I am of lawful age and competent to sign this Release, and have done so voluntarily. I understand that this document constitutes a full and complete waiver of all possible claims, either while on the trip or upon my return, for any act or omission, including claims for negligence regarding injury, illness or property damages, arising out of my participation in the trip. I understand that this Release applies to, covers, and includes unknown, unforeseen, unanticipated, and unsuspected damages, losses, or liabilities and the consequences thereof, which result from the matters herein before inferred to as well as those now disclosed and known to exist. 

We count it a real privilege to assist you in your desire to participate in reaching people with the Gospel of our Lord Jesus Christ.

*Having read the Risk Statement, I am aware of the hazards and risks to my person and property associated with serving overseas in a missions capacity.
*I certify that I will not hold SCC liable for injury, disease, or delay of return, or any other claims, while undertaking a short-term missions trip with SCC.
*I understand and accept the SCC policy regarding ransom payments described in the Risk Statement.
*I understand that donated funds sent in to SCC for the trip are not refundable.
*I understand and acknowledge that I am responsible for the full amount of the mission trip, or all costs associated with my participation, up to the point of cancellation.
*Photo and Image Release (Click to read the SCC Photo and Image Release document.)
All Mission Trip team members are required to fill out a background check.  If you have not previously filled one out or have not done so in the past two years, please click Background Check Release Authorization Form to do so now. (Form will open in a new window.)
By my electronic signature provided below, I certify that I have read, understand and agreed to comply with the Liability Waiver.
*Electronic Signature (Full Name):