____________________________________ Long Hollow Baptist Church | Hendersonville / Gallatin/ White House

TEAM MEMBER MISSION TRIP GUIDE • • • • • • •

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TEAM MEMBER APPLICATION MISSION TEAM FINANCIAL DEADLINE SCHEDULE RELEASE OF LIABILITY FORM/PARENT AFFIDAVIT FORM BACKGROUND INFORMATION FORM SUMMARY OF INSURANCE COVERAGE PASSPORT & VISA PROCEDURES MAKING THE MOST OF YOUR MISSION TRIP o IDEAS FOR BUILDING YOUR SUPPORT TEAM o MY SUPPORT TEAM o SAMPLE SUPPORT LETTER o SAMPLE FOLLOW-UP LETTER o PRAYER COVENANT LIST o PRAYER GUIDE FOR YOUR MISSION TRIP o HOW TO SHARE YOUR TESTIMONY o JOURNALING

TEAM MEMBER APPLICATION PERSONAL INFORMATION_____________________________________ Name: _________________________________________ !! Address: _______________________________________ City:______________ State:______Zip:______________ !!!!!"#$%&#'"!#(! Mailing Address (if different): ____________________ !!!!!!!!!!!!'))'*+! City______________ State:______ Zip: _____________ Telephone (home/school): _____________________ !!!!!!!!!!!!!,+#)#! (Work): __________________ (Cell): _______________ E-MAIL ________________________________________ ! Date of birth: Month: ______Day: _____Year:______ !!!!!!!!!-#,).#%'&! Marital Status:: _________________________________ If Married, Spouse’s name:______________________ Gender: M/F If not a member of Long Hollow Baptist, please provide the following: Present church membership:_________________________________ Pastor’s name:______________________________________________ TRAVEL INFORMATION________________________________________ Name as it appears on driver’s license: _______________________ Driver’s license number: _____________________________________ Do you have a passport: Yes/No/Applying Exact name as appears on passport: _________________________ Passport Number: _________________________ EXP. Date: ________ Date of Passport Issue: _______________________________________ EMERGENCY CONTACT INFORMATION_________________________ Emergency Contact: ________________________________________ Phone: _____________________ Relationship to you: _____________ Insurance Beneficiary: _______________________________________ Relationship to you: _________________________________________ HEALTH INFORMATION (OPTIONAL) Health Insurance Company: _________________________________ Name of Policyholder: _______________________________________ Your relationship to Policyholder: _____________________________ ID Number: _______________________ Group Number: __________

Primary Care Physician: ________________________________________________ Physician’s Phone: _____________________________________________________ Identify any health considerations that might impact your participation in a missions setting or any physical needs that require special assistance: ________________________________________________________________________ ________________________________________________________________________ List medications and dosages you are currently taking: MEDICATIONS: DOSAGE: ____________________________ ____________________ ____________________________ ____________________ ____________________________ ____________________ List all known allergies: _________________________________________________

PARTICIPANT’S COVENANT I hereby pledge to give priority to spiritual preparation for my Mission Team assignments, to read all orientation materials, attend all required training sessions, and seek the heart of a servant. I further promise to be flexible in all situations, particularly those out of my comfort zone and will do everything I can, as God gives me the strength, to be pleasing to Him. I UNDERSTAND THAT I MAY BE REQUIRED TO PROVIDE A 10% NON-REFUNDABLE DEPOSIT WITH THE SUBMISSION OF THIS APPLICATION. I FURTHER ACKNOWLEDGE THAT SHOULD I CANCEL, ALL MONIES, WITH THE EXCEPTION OF 10% DEPOSIT AND AMOUNT OF PLANE TICKET PURCHASED IN MY NAME, WILL BE REFUNDED. I ACKNOWLEDGE THE INFORMATION I PROVIDED IN THIS APPLICATION IS NOT CONFIDENTIAL AND CAN BE ACCESSED BY A VARIETY OF PEOPLE RELATED TO CHURCH ACTIVITIES. PARTICIPANT’S SIGNATURE ___________________________________________DATE_________________ PARENT/GUARDIAN SIGNATURE (IF PARTICIPANT IS A MINOR) ___________________________________________DATE _________________

MISSION TEAM FINANCIAL DEADLINE SCHEDULE Please note that your Mission Team Leader will provide the information needed below.

ESTIMATED COST OF MISSION TRIP

$___________________

With Application

10% Deposit Due ____________

Date__________________

Amount Due $________________

Date__________________

Amount Due $________________

Date__________________

Balance Due $_________________

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