Ft. Wayne, Indiana Mission Trip
Why Ft. Wayne: There is a large population (estimated about 6,000) Burmese refugees living in Ft. Wayne. Currently, Uncharted has 11 orphanages, a Bible college, several church planters, and over 200 house churches in Myanmar. It is our desire to work with the same people groups we work with overseas. Religions: Of the 6,000 people living in Ft. Wayne, it is estimated about 1/3 are Christians; 1/3 are Muslim; and 1/3 are Buddhist. Who Can Go: This is the perfect trip for Middle School and High School student groups, but individuals of all ages, including families, are more than welcome to participate. Students 5th grade and below must have at least one parent traveling with them. Dates: Saturday, June 20 to Thursday, June 25 What will we do: Minor construction projects, VBS camp (including games, crafts, Bible teaching, etc.), and possibly a few other things. We will work with the local church in Ft. Wayne as we serve the Burmese. How Much Does It Cost: $300 total which includes food, transportation, lodging, and supplies. A $100 NON-refundable deposit is due when you sign up, with an additional $50 due at each of the team meetings listed below. How Do I Sign-Up: Turn in $100 and a completed, signed, and notarized trip application by April 5 and agree to attend the following team meetings: Sunday, April 12 (additional $75 due) Sunday, May 3 (additional $75 due) Sunday, June 7 (final $50 due)
Questions: call Geoff Bunting in the Uncharted Office (812-402-1886)
Ft. Wayne, Indiana Mission Trip Short-Term Mission Trip Application Personal Data: Full Legal Name (F, M, L): ________________________________________________ Nickname: _____________________________________________________________ Full Mailing Address: _____________________________________________________ ______________________________________________________________________ E-mail: ________________________________________________________________ Home Phone:_____________________ Work Phone: __________________________ Cell Phone: ____________________________________________________________ Date of Birth: _____________________ Place of Birth: __________________________ Shirt Size: _________________ If under 18 years of age, Names of parent(s) or guardian(s): ______________________________________________________________________ Parent/Guardian Cell Phone: ______________________________________________
Church Involvement Do you regularly attend worship services? ____Yes ____ No Church Name: __________________________________________________________ How long have you attended the above church? _______________________________ Have you ever served in a ministry at the above church?____ Yes ____No Which ministry: _________________________________________________________ How Long: _____________________________________________________________
Occupation: Please describe your present employment and any pertinent information regarding work experience related to missions. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Favorite Food:___________________________
Ft. Wayne, Indiana Mission Trip Medical Information Do you have any physical limitations that would hinder your ability to participate in vigorous activities? If so, please explain. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ List any medical conditions, allergies, medications, etc. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Describe your present physical fitness (e.g. for walking, manual labor, heavy lifting, carrying objects). ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
Personality Profile Have you ever taken a Spiritual Gifts Test? ____ Yes ____ No What do you feel your top three Spiritual Gifts are? _____________________________ ______________________________________________________________________ Describe how OTHERS view your personality: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Describe your personal strengths: __________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Describe your personal weaknesses: ________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Do you have previous mission experience? When, how long, and where: ______________________________________________________________________ ______________________________________________________________________
Ft. Wayne, Indiana Mission Trip
My Personal Relationship with Jesus Christ and Mission Goals Do you consider yourself a Christian? If so, when did you become one?_____________ Describe your personal relationship with Jesus Christ. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
Why would you like to participate in this trip? ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ What would make this mission trip a success for you? ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Explain what the “Good News” or “Gospel” is (in your own words, as you understand it) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
Ft. Wayne, Indiana Mission Trip Short-Term Mission Medical Information and Release This form must be filled out and signed in order for you to participate in a Short-Term Mission Trip with Uncharted International. Name: ________________________________________________________________ Address: ______________________________________________________________ City: ______________________ State: ________ Zip: _______________________ Home Phone: _______________________ Work Phone: _____________________ Cell Phone: ____________________________________________________________ Medical Insurance Provider: _______________________________________________ ID #: _________________________ Group #: ______________________________ Name of Primary Physician: _______________________________________________ Phone: _______________________________________________________________ Emergency Contact: _____________________________________________________ Relationship: _______________________ Phone: __________________________ Please check if you suffer from any of the following medical conditions: ____Hypertension ____Hypoglycemia ____Bleeding Disorders ____Heart Disease ____Seizures ____Insect Allergies ____Asthma ____Glaucoma ____Chronic Anxiety ____Diabetes ____Migraines ____Depression ____Arthritis ____Other________ ____Other _________________ List any physical limitations and/or conditions: _________________________________ ______________________________________________________________________ List any medications (prescription or OTC) taken on a regular basis: ______________________________________________________________________ ______________________________________________________________________ List Allergies: ___________________________________________________________ ______________________________________________________________________ Have you had any surgery in the past three years? ____ Yes ____ No If so, please explain: _____________________________________________________ ______________________________________________________________________ In an emergency, I give my permission to a licensed physician to hospitalize, anesthetize, or perform surgery on me. I understand that every effort will be made to inform my emergency contact before these actions are taken. Signature: _______________________________
Date: ______________________
Parent/Guardian Signature: _________________________ Date: ________________
Ft. Wayne, Indiana Mission Trip Short-Term Missions Trip Release of Liability In signing this form, I, _____________________ agree not to hold Uncharted International, Inc., Bethel Temple Community Church, Crossroads Christian Church, The Methodist Temple, Catalyst Church, One Life Network, Inc., or One Life Church, their officers, employees, or other agents liable for any injury, loss, damage, or accident that I might encounter while on one of their mission trips. I realize and acknowledge that my participation on a mission trip in the US or to a foreign country includes many risk sand possible dangers. I am well aware that my travel to a foreign country or in the USA exposes me to such risks as accidents, disease, war, political unrest, injury from construction projects, and other calamities. I have carefully read the foregoing and I understand that my signature herein holds Uncharted International, Inc., Bethel Temple Community Church, One Life Network, Inc., or One Life Church, Crossroads Christian Church, Christian Fellowship Church, their officers, employees, or other agents harmless for any liability for injury, damage, loss, accident, delay, or irregularity in schedule. Signed: _______________________________________________________________ Parent/Guardian Signature: _______________________________________________ and dated this ________ day of ______, 20_____. Witnessed by: ____________________________ State of ____________________, _______________ County. On the ____ day of ____ 20__ before me personally appeared to the known to be the person(s) who executed the above release, and acknowledge that voluntarily executed same. Notary Public ________________________________________________ Date of Expiration of Notary Commission: __________________________
Ft. Wayne, Indiana Mission Trip Team Covenant As a member of this team, I agree to: • Remember that I am representing Uncharted International, Inc., and more importantly, Jesus Christ. I will model Jesus in my behavior and attitude. • Remember that I am a guest working at the invitation of my hosts. I will remember the missionary’s prayer, where you lead me I will follow; what they feed me I will swallow!!! • Remember that we have come to learn, serve, teach, as well as to play with the kids. I’ll resist the temptation to inform our hosts about how we do things. I’ll be open to learning about other people’s methods and ideas. • Respect the host’s view of Christianity recognizing that Christianity has many faces throughout the world and that the purpose of this trip is: to experience faith lived out in a new setting, serve our missionaries, serve our God by loving and submitting to others, and encourage everyone I come into contact with. • Develop and maintain a servant attitude toward all nationals and teammates. • Respect my team leaders, unit leaders, and their decisions. • Refrain from gossip. • Refrain from complaining. I know that travel can present numerous unexpected and undesired circumstances, but the rewards of conquering such circumstances are innumerable. Instead of whining and complaining, I’ll be creative, submissive, loving, compassionate, and supportive. • **Attend all team meetings before the trip as well as any follow-up meetings. • Remember not to be exclusive in my relationships. If my boyfriend/girlfriend or spouse is on the team, we will make every effort to interact with all the members of the team. If I am attracted to a teammate, I will not attempt to pursue a relationship until after we return home. • Refrain from any activity that could be construed as romantic interest toward a national. • I am not involved with illegal drugs and will abstain from consumption of alcoholic beverages or the use of tobacco while on this trip. • I agree to personally thank all financial donors and prayer partners. • I agree to dress respectfully according to the customs of that country. • FINANCIAL RESPONSIBILITY I agree to pay all remaining balances of my account by June 23, 2013. Also, if at any time while on the project my behavior constitutes a problem, the team leader has the authority to ask me to return home. Any additional cost incurred as a result of this action will be at my expense. Signed: ________________________________
Date: ______________________
Parent/Guardian Signature: _________________________ Date: ________________
Ft. Wayne, Indiana Mission Trip Team Covenant (your copy) As a member of this team, I agree to: • Remember that I am representing Uncharted International, Inc., and more importantly, Jesus Christ. I will model Jesus in my behavior and attitude. • Remember that I am a guest working at the invitation of my hosts. I will remember the missionary’s prayer, where you lead me I will follow; what they feed me I will swallow!!! • Remember that we have come to learn, serve, teach, as well as to play with the kids. I’ll resist the temptation to inform our hosts about how we do things. I’ll be open to learning about other people’s methods and ideas. • Respect the host’s view of Christianity recognizing that Christianity has many faces throughout the world and that the purpose of this trip is: to experience faith lived out in a new setting, serve our missionaries, serve our God by loving and submitting to others, and encourage everyone I come into contact with. • Develop and maintain a servant attitude toward all nationals and teammates. • Respect my team leaders, unit leaders, and their decisions. • Refrain from gossip. • Refrain from complaining. I know that travel can present numerous unexpected and undesired circumstances, but the rewards of conquering such circumstances are innumerable. Instead of whining and complaining, I’ll be creative, submissive, loving, compassionate, and supportive. • **Attend all team meetings before the trip as well as any follow-up meetings. • Remember not to be exclusive in my relationships. If my boyfriend/girlfriend or spouse is on the team, we will make every effort to interact with all the members of the team. If I am attracted to a teammate, I will not attempt to pursue a relationship until after we return home. • Refrain from any activity that could be construed as romantic interest toward a national. • I am not involved with illegal drugs and will abstain from consumption of alcoholic beverages or the use of tobacco while on this trip. • I agree to personally thank all financial donors and prayer partners. • I agree to dress respectfully according to the customs of that country. • FINANCIAL RESPONSIBILITY I agree to pay all remaining balances of my account by June 1, 2014. Also, if at any time while on the project my behavior constitutes a problem, the team leader has the authority to ask me to return home. Any additional cost incurred as a result of this action will be at my expense. Signed: _______________________________
Date: ______________________
Parent/Guardian Signature: ___________________________
Date: ___________
