missions application general

Participant Application and Release Form (Form Revised Dec, 2016)

Short Term 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.

Instructions: Please fill out this form entirely, turn it in to Kim’s box with a $100 deposit, a copy of your passport picture page, and your 1-page testimony attached. Print from here or copy/paste it into another document. (This form cannot be filled in on this site.)

Participant Information-Personal Profile

Full PASSPORT Name ____________________________________________

Preferred Name _____________________

Date of Birth _______________________

Home Address_______________________________________________________________

Email Address (print clearly)_____________________________________________________

Cell Phone Number: l (        )                      .

 

Emergency Contact Name (at home) (relationship): ______________________________________

Phone #: _____________________________________________________________________

Emergency Contact E-mail address __________________________________________________

 

Male / Female

Occupation __________________________________________________________

Single / Married --Name of Spouse ________________________________________

Past World Missions Experience __________________________________________

____________________________________________________________________ 

Valid Passport Number & Expiration Date ___________________________________

Passport Country and Date of Issue _______________________________________

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

At its discretion, Inverness Vineyard Church may use the above information to plan the IVC Short Term 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.

 

Personal Experience and Giftings

Please attach a one-page testimony of your conversion and lived Christian experience. Include a life-theme verse here if you have one.

Why do you want to go on this particular mission trip?_____________________________

_______________________________________________________________________

_________________________________________________________________________

What do you expect to be the outcome of this investment of time & resources? ___________

_________________________________________________________________________

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, draw a line under the number that those who know you best might use to describe you)

1  2  3  4  5  6  7  8  9  10

Gift Mix as shown in Vineyard Discovery class, or find a giftings test online and report those results:

Highest three __________________________           Lowest scores __________________

_______________________________                      ___________________________

_______________________________                      ___________________________

What topics do you feel prepare to minister in? ____________________________________

_________________________________________________________________________

 

 

Application and Release

I, ___________________ , apply to Inverness Vineyard Church to participate in the mission trip to be conducted in ___________________, scheduled for the dates from___________ to ___________, 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 CHURCH 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.

Text Box: As per IRS rules, donations to a church are given, and the leadership has final discretion as to how funds are used. That said, we will do our best to function in integrity and faithfully use funds. I understand that monies paid into my missions account are not refundable to me.  If I discover I cannot go, I understand that I may request a transfer of the money I have paid, earned or had donated to me to another missionary, or the general missions fund._____InitialComplete 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.

 

Applicant Signature _____________________________________________

Witness/Date _________________________________________________

Applicant accepted for participation by Inverness Vineyard Church by:

Signature, Title, Date _____________________________________________________________


(if unneeded, you may delete the following section electronically before emailing a filled in application)

Parental Consent

Parental Consent form must be completed if participant is under the age of 18 at the time this Instrument is signed.

I, , a custodial parent or guardian of the child identified above give consent for that child to participate in the trip (as defined above), and agree to the following, in consideration of the mission opportunities and consulting services provided by INVERNESS VINEYARD CHURCH. I also give permission for Inverness Vineyard Church or a participant in the trip designated by one of them to take or authorize any action it, he, or she deems necessary or appropriate, including emergency anesthesia or surgery, in the event of a personal injury to my child.

I hereby acknowledge the risks to my child and myself identified above in the section captioned “Acknowledgment of Risks”. I represent that my child is in good health. I have or will discuss my child’s participation in the trip with his or her physician, have or will assure that my child has received any vaccination the physician deems necessary, and will allow my child to participate in the trip only if I have received the physician’s approval and believe that my child is able to endure the strain that my be associated with such participation. I understand that my child’s participation in the project is contingent upon agreement by Inverness Vineyard Church, but that Inverness Vineyard Church is not taking the responsibility to assess and approve my child’s fitness for participation. My child and I apply for him or her to participate in the trip as my child’s and my own free act. No employer or other person, and no circumstance, has placed my child or me under any economic, physical, or other force or duress to compel his or her participation in the trip, or my child’s or my signing of this Instrument. I also make the promises identified in the section captioned “Covenant Not to Sure, Release, and Indemnification” above, and agree to the provisions in the section captioned “Governing Law and Disputes above, on behalf of my child and ON BEHALF OF MYSELF.

I HAVE COMPLETELY READ THIS INSTRUMENT, UNDERSTAND IT, AND UNDERSTAND ALSO THAT I AM WAIVING LEGAL RIGHTS THAT MY CHILD OR I MAY HAVE IN THE EVENT THAT MY CHILD OR I SUFFER DAMAGE, LOSS, HARM, OR DEATH. INVERNESS VINEYARD CHURCH and I may amend this Instrument only in writing signed by all of us.

Parent Signature ______________________________________

Witness/Date __________________________________________

Applicant accepted for participation by Inverness Vineyard Church by:

Signature Title Date ________________________________________________

_______________________________________________________________

 

Form Revised December, 2016