CONFIDENTIAL MINISTRY APPLICATION


Name: *
Name:
Date:
Date:
Address:
Address:
Home Phone:
Home Phone:
Cell Phone:
Cell Phone:
Expires:
Expires:
Date of birth:
Date of birth:
Phone:
Phone:
Address:
Address:
Phone:
Phone:
Fax:
Fax:
Physician's Address:
Physician's Address:
Physician's Phone:
Physician's Phone:
Physician's Fax:
Physician's Fax:
Date of last physical:
Date of last physical:
If so, please provide a copy of the procedures, (including required policy numbers and phone numbers) describing how your medical insurance is notified in the event of an illness. (Please attach procedures.)
Note: Applicants (and their spouses) will be required to sign a limited power of attorney and a release of liability. I agree that I have carefully read the application letter stating the qualifications for applicants, the nature of the mission, and my responsibilities as a potential team member. I realize and/or agree that: The missions may be extremely dangerous, including, but not limited to, poisonous conditions and substances, and deadly animals, harmful or deadly diseases, and the possibility of being kidnapped, captured, imprisoned, and/or killed. The physical conditions may be extremely difficult: very hot and humid, primitive living conditions without running water, electricity, sanitation facilities, or medical facilities. (it may take days to get to a hospital or clinic). I must be spiritually prepared: walking in the Spirit, having a free conscience, free from moral compromise. I will pray regularly and faithfully for my participation, for my team, and for those to whom we will minister. I must be physically prepared: in good physical shape, not suffering from serious medical/physical problems. I must have the support of my spouse, my spiritual leaders, and a team of prayer partners. I will strive to maintain unity and function as a part of the team: not going off on my own, not pursuing my own agenda, refraining from grumbling, gossip, and complaining. I will submit to those in authority over me (including their decision to send me home if necessary), and accept any task they may assign, including the possibility that I may be left in a support position behind the front lines. I will neither pursue, nor respond to any romantic relationships during mission trips. I will obtain all the required and recommended vaccinations. I will work diligently to raise the financial support necessary to help pay for my participation in the mission. I will refrain from the use of any tobacco products and the consumption of alcoholic beverages during the mission trip. Also With the exception of over-the-counter non-prescription medicines, I will refrain from the use of any drugs unless prescribed by a doctor during this time as well. Mission International may change or cancel any mission trip, even up to the last minute I understand that in the event that I cancel this trip, all or part of your expenses may not be refunded to me. *
Please send an email to -- Tony.m@ccsjc.com with an attached passport sized photo.
Signature:
Signature:
Date:
Date: