Application for Orangeville Baptist Church



Expedition Participant Application

Personal Information:

Last Name_______________________________ First Name ___________________________________

Address __________________________________________________________________________________ City ___________________________ Province _________________ Postal Code __________________

Date of Birth ______/______/______ (d/m/y) E-Mail Address: ____________________________________

Home Phone (___) ______________ Citizenship ______________ Country of Birth ____________________

Name of Parents / Guardian: __________________________________________________________________

Cell Phone: ___________________________ E-Mail Address: __________________________________

Emergency Contact if other than parent: _________________________________________________________

Passport Information

Full name as in Passport (or as will appear on your passport application)

______________________________________________________

Passport Number ________________________ Expiration Date of Passport _________________________

Travel Health Insurance

Name on Policy: _________________________ Company: _________________________________

Policy #______________________ worldwide contact phone #_____________________________________

I will be acquiring Travel Health Insurance to cover me over the time frame of the trip: ___________________

Health, Meds, Allergies (Please list and explain)

Is there a health condition we should be aware of?

Skill / Interests

Please list all specialized skills including languages other than English that you have developed and are able to use: (i.e. medical, teaching, construction, culinary, music, arts and crafts, audio visual, photography, sports, leading, other)

Skill Fair Good Excellent Interest in developing

___________________________________ ______ ______ ______ _______

___________________________________ ______ ______ ______ _______

___________________________________ ______ ______ ______ _______

___________________________________ ______ ______ ______ _______

___________________________________ ______ ______ ______ _______

List any previous cross-cultural experience (inner city, another country, international student, refugees) ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Spiritual Life

If you consider yourself a follower of Christ describe how and when you became one, if not explain why?

__________________________________________________________________________________________ __________________________________________________________________________________________

__________________________________________________________________________________________

Describe what your relationship with Christ looks like.

__________________________________________________________________________________________ __________________________________________________________________________________________

__________________________________________________________________________________________

Do you attend a local church _______yes _________no

If yes, where do you attend and how are you involved? ___________________________________________________________________________________________________________________________________________________________________________________

Trip Interest

List the reasons why you would like to go on this trip?

What do you hope to gain from the experience?

Terms and Conditions

Every participant will:

• Invite as many family members, friends, and people in your circles of influence to support you prayerfully and financially in relationship during this trip

• Be a blessing to the national hosts and team.

• Submit own personal preferences (privacy, food, dress, etc.) to the standards of the national hosts and team

• refrain from alcoholic drink and smoking

• willingly submit to team leader(s) in all things throughout the project

• build up fellow team members

• Participate fully and willingly in all pre-trip and post-trip meetings / preparation and debriefing as required.

• Willing to carry out the objectives of the projects

• Willing to commit the time, money and effort required

• Willing to share the ministry experience with congregation/community/sphere of influence upon return

• willing and able to participate in preparatory times of training, team building and fundraising

• willing to submit to leadership

• willing to participate in the debriefing / re-entry process

• be physically, mentally and emotionally healthy

2. I acknowledge that all funds required to participate on this trip will be given according to the set payment schedule. My failure to do so will mean that I will voluntarily withdraw from the team, pay any financial penalty attached to canceling airline and accommodation reservations. Any funds already given shall be used for the projects pertaining

Signed ____________________________________ Date _________________________

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