Participant Application and Release Form (Form Revised Dec, 2016)
Israel Mission Trip – Inverness Vineyard Church (IVC)
IVC Short Term Mission trips are not designed as “typical tourist vacations.” Most trip sites require travel to remote areas of the world where logistical requirements for volunteers may involve unconventional modes of transportation and/or accommodations. In addition, Inverness Vineyard Short Term Mission trips will contain the full range of risks and inconveniences resulting from both travel and volunteer service: physical labor, timing delays, frustrations, surprises, etc. Because of the circumstances involved with these trips, we want to make certain you understand that the circumstances mentioned above are a part of this type of experience.
As a necessary precaution, Inverness Vineyard Church requires that each program participant understand and execute the following release and agreement. Please print this page or copy/paste it into a new document. This application cannot be filled in on this webpage.
Participant Information-Personal Profile
Full PASSPORT Name ____________________________________________
Preferred Name __________________________________________________
Date of Birth ____________________________________________________
Passport number & Country of Issue __________________________________
Passport Expiration Date ___________________________________________
Email Address ___________________________________________________
Cell Phone Number: ( ) .
Emergency Contact at home (relationship): ____________________________________________
Phone #: _____________________________________________
Emergency Contact E-mail address __________________________________________________
Male / Female
Single / Married --Name of Spouse ________________________________________
Roommate Preference __________________________________________________
Past World Missions or Travel Experience ___________________________________
Medical Information. (will be kept in your file and released to your team leader before your journey to be used in case of a medical emergency).
Known Allergies: ________________________________________________________________
Handicaps or health restrictions: ____________________________________________________
Prescriptions or medication presently being taken: _______________________________________
Are you currently under a physician’s care? If so, condition? _______________________________
Can you swim? □ Yes □ No
Occasionally location stops in Israel are either walking intensive, and/or over rough terrain or can occur in extremely tight quarters. There may be times when you need to be excused from an activity. Ask your team leader if you have any questions regarding suitability of any activity for you and an alternative will be sought. At its discretion, Inverness Vineyard Church may use the above information to plan the IVC Israel Mission trip. It will not use the information to determine your physical or emotional readiness to serve. You and your personal physician must determine your readiness and make arrangements for your health and physical requirements without relying on any action before, during, or after the trip by Inverness Vineyard Church or other participants.
Please attach a one-page testimony of your conversion and lived Christian experience. Include a life-theme verse here if you have one.
On a scale of 1-10, ten being most flexible, how do you assess your ability to adapt to changing plans at a moment’s notice? (circle the number that you use to describe you, underline under the number that those who know you best might use to describe you).
Flexibility scale: 1 2 3 4 5 6 7 8 9 10
Introvert or Extrovert? Morning person or night person? (used for room assignments for singles and prep for team leader)
I commit to attending an Israel Seminar or read Israel Basics or Why Still Care About Israel to prepare my heart for the coming changes I will experience in the Land. ______(initial)
Application and Release
I, ___________________ , apply to Inverness Vineyard Church to participate in the mission trip to be conducted in _______Israel______, scheduled for the dates from_Oct 23, 2017_ to _November 4, 2017_, regarding which Inverness Vineyard Church has and will provide consulting services regarding selection, planning, and coordination. In consideration of the mission opportunities provided to me by the sponsoring church, and through the consulting services provided by Inverness Vineyard Church, which I agree are adequate consideration, I agree to what follows.
Acknowledgment of Risks. I understand and acknowledge that due to the nature of the trip, preparing for it, traveling to and from it, and actually participating in it, involves RISKS OF DAMAGE TO OR LOSS OF PROPERTY, HARM TO MY BODY, MENTAL FACULTIES, OR EMOTIONS, OR THOSE OF MY FAMILY, AND EVEN DEATH; and I ASSUME THOSE RISKS. Sources of damage, loss, harm or death may include, but are not limited to, (1) harmful acts or failures to act in harmony with employees, agents and volunteers of Inverness Vineyard Church and other trip participants, who have varying levels of knowledge, experience, and judgment; (2) a remote, primitive, unsanitary, dangerous and at times inaccessible site; and (3) dangerous construction work. I acknowledge that Inverness Vineyard Church is taking responsibility to assess or approve the fitness of the IVC Short Term Mission trip participants. I understand and acknowledge that Inverness Vineyard Church will act according to recognized mission agency procedures in the unlikely even of a kidnapping or hostage situation: and will attempt to negotiate the release of a trip participant, but will not encourage the future abduction of missionaries by paying a ransom of any kind.
Facts About Me.
I am _______ years old. I am in good health and sound mind, and able to understand this Instrument. I have or will discuss my participation in the trip with my physician, have or will receive any vaccination he or she deems necessary, and will participate in the trip only if I have received his or her approval and believe that I am able to endure the strain that may be associated with such participation. I understand that my participation in the trip is contingent upon agreement by Inverness Vineyard Church, but that Inverness Vineyard Church is not taking the responsibility to assess and approve my fitness for participation in the trip or my signing of this Instrument.
Covenant Not to Sue, Release, and Indemnity. I promise the following: (a) I WILL NEVER SUE INVERNESS VINEYARD CHURCH FOR DAMAGES, INCLUDING DAMAGES RESULTING FROM INVERNESS VINEYARD CHURCH’S NEGLIGENCE (BUT NOT ITS WILLFUL AND WANTON MISCONDUCT.) That means that I hereby agree and covenant not to institute and suit or action at law or at equity against Inverness Vineyard Church. I intend this Instrument to be defense to any such suit or action, and a complete bar to the commencement and prosecution of any such suit or action. (b) I RELEASE AND DISCHARGE INVERNESS VINEYARD CHURCH FROM, AND WAIVE, ANY AND ALL LIABILITIES. (c)I WILL INDEMNIFY, HOLD HARMLESS, AND DEFEND INVERNESS VINEYARD CHRUCH FROM ANY AND ALL LIABILITIES, INCLUDING LIABILITIES ARISING FROM ITS NEGLIGENCE, (BUT NOT ITS WILLFUL AND WANTON MISCONDUCT), AND INCLUDING LIABILITIES ARISING FROM MY ACTIONS.
Definitions. When I use the following words, I mean the following: (a) “DAMAGES” means any damage of every kind and nature, including damage or loss to property, financial loss, harm to body, mental faculties or emotions, or death, resulting from, in connection with, or in any way related to the trip weather caused by Inverness Vineyard Church’s negligence (but not is willful and wanton misconduct), or any other cause. “DAMAGES” includes, but is not limited to, damage that occurs or is caused during the planning of, preparation for, travel to or from the site of, and actual conduct of, the trip. (b) “I” means myself, my spouse, and my insurers, heirs, estate, legal representative, executor, administrators, successors, and assigns.
(c) “LIABILITIES” means any liability of every kind and nature in connection with my participation in the trip, including any and all causes of action, actions, suits, claims, demands, rights, damages, judgments, executions, court costs, attorney’s and other legal fees, and including such liabilities that arise from claims for contribution by others that I have sued or from whom I have received compensation for DAMAGES. (d) Inverness Vineyard Church means its directors, officers, employees, agents, volunteers, affiliates, associates, sponsoring churches, and cooperation institutions, and the spouse, insurers, heirs, estates, legal representatives, executors, administrators, successors, estates, and assigns of the foregoing.
Governing Law and Disputes. I agree that the laws of the State of Alabama only will govern every aspect of this Instrument, and my rights and responsibilities in connection with the trip. I intend this Instrument to be as broad and inclusive as permitted by the laws of the State of Alabama. I may sue only in state or federal court in Shelby County, Alabama.
Complete Reading and Understanding. I HAVE COMPLETELY AND CAREFULLY READ THE FOREGOING, UNDERSTAND IT, AND UNDERSTAND ALSO THAT I AM WAIVING LEGAL RIGHTS THAT I MAY HAVE IN THE EVENT THAT I SUFFER DAMAGE, LOSS, HARM, OR DEATH. INVERNESS VINEYARD CHURCH and I may amend this Instrument only in writing signed by all the undersigned.
Please attach a copy of your passport that is valid for at least 6 months after our return (May 2018).
Applicant Signature _X____________________________________________
Applicant accepted for participation by Inverness Vineyard Church by:
Signature, Title, Date _____________________________________________________________