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Mission Trip Registration

SSM Mission Trip to Ft. Worth


3/9/2020 - 3/13/2020
$245.00

Additional Information

Information listed above (and below) should be for the student applying for the mission trip. (If the student does not have an e-mail address or cell phone, please list the parent's instead.)

Please have your student fill out this application to the best of his/her ability. The student is the one making a commitment to this Mission Trip.
*Gender:
*Date of Birth:
Please select your grade:
*Select grade:
*Parent (1)/Legal Guardian's Name:
*Parent (1)/Legal Guardian's Relationship to Attendee:
*Parent (1)/Legal Guardian's Cell Phone Number:
*Parent (1)/Legal Guardian's Email Address:
Parent (2) Information (If there is no Parent (2), please provide an alternate emergency contact.)
*Parent (2) (or alternate contact) Name:
*Parent (2) (or alternate contact) Relationship to Attendee:
*Parent (2) (or alternate contact) Cell Phone Number:
*How would you describe your relationship with Jesus?

I am committing myself to join the Student Ministry Missions Team. I understand that, because of the advance deposits, payments and time spent preparing for this trip, I am making a commitment and I will not back out.  In addition, I understand the expectations of me while on this trip include (but are not limited to) the following:
Parents, please fill out this section:
****Please fill out the Medical Form for 2020. It is good through the end of 2020.*** It is your responsibility to notify us of any changes to this information. If you have not filled out a form, your child will not be able to participate.
*Image Release Accept/Decline (A copy can be found here.)
*I have read/my student has read the Stonebriar Student Ministry Code of Conduct and my student agrees to follow the rules as they are outlined here.  My student understands that if he/she breaks the rules, the Student Ministries Staff will take disciplinary action.  Disciplinary action may include being asked to correct a behavior, restriction from activities, staying with a staff member, restitution for broken items, confiscation of property, a call home to parents, or in cases of gross misconduct, being sent home.
*All mission trip donations, including the deposit are tax-deductible and non-refundable. If a participant is unable to go, the funds that they raised will be used to help with general mission trip costs. Also, if the participant cannot raise and/or pay the full $245, he/she will be unable to attend.
*The full trip cost of $245 must be paid by March 8 (day before the trip) in order to attend.
By my electronic signature provided below, I certify that I have read, understand and agreed to comply with the Photo Recording and Image Release, Assumption of Risk, Exhibit A, Consent to Treat and Student Ministry Code of Conduct statements and agreements listed here.
*Parent Electronic Signature (Full Name):