City. State. Zip Code. Phones: ... Phone Number (home): ... or dentist (as appropriate) licensed to practice under the l
APPLICATION FOR HIGH SCHOOL Page 1 of 3 YOUTH MISSION TRIP 2016 – HILTON HEAD, SC – JULY 10-16, 2016 Date: ______/__________/________________
Basic Information
PPC Youth
Name: _______________________________________________________________________________________________________________________________ First MI Last Street Address: ____________________________________________________________________________________________________________________
Street
____________________________________________________________________________________________________________________
City
State
Zip Code
Phones: ______________________________________________________________________________________________________________________________
Home
Work
Cell
Email: _______________________________________________________________________________________________________________________________ Parent Email: _______________________________________________________________________________________________________________________ Church Member: Member
Regular Attendee
Other _______________________________________________________________ (Visitor/Name of Other Church)
How long have you regularly attended this church? ____________________________________________________________________________ Year in School:___________________________ Name of school you attend: ___________________________________________________________ Father’s Name: ____________________________ Phone Number (home): ____________________________ (cell) __________________________ Mother’s Name: ___________________________ Phone Number (home): ____________________________ (cell) __________________________ Emergency Contact:_________________________________________ (home): ____________________________ (cell) __________________________
Tell us about yourself
1. What are your expectations of this mission trip experience? 2. Why would you like to attend this trip to Johnstown?
Mission Work Experience
What other mission trips have you been on and what did your group participate in? What skills do you have that would be useful while working in Puerto Rico?
APPLICATION FOR HIGH SCHOOL Page 2 of 3 YOUTH MISSION TRIP 2016 – HILTON HEAD, SC – JULY 10-16, 2016 Food Information
PPC Youth
What’s one meal that you would like to see cooked on the trip for either breakfast, lunch, dinner, or dessert? Do you have any food allergies that we need to know about? _________________________________________________________________ What is your least favorite food?_________________________________________________________________________________________________ Vegetarian?
Yes
/
No
Are you willing to eat PB&J in cases that you do not like the food that is being served?
Medical information
Yes
/
/
No
Yes
Have you had any prior injuries that might be aggravated by this mission trip?
Yes
Do you have any allergies to medicines or other things that we might come across during the trip? Yes / No Are you currently taking and medication prescribed by a doctor for physical or other condition that would affect your ministry? Yes / No Do you have any medical condition(s) that might be hazardous to others?
Yes
/
No
If you answered yes to any of the questions above, please attach another page and explain completely.
Liability Release
I Hereby give my permission for my child ___________________________________________________ to participate in the summer mission trip with Adventures in Mission organized by Paoli Presbyterian Church (PPC) and Adventures in Mission (AIM). I hereby release, hold harmless and absolve PPC, their officers, staff, sponsors, vendors, and all others who have participated in the planning, organizing and implementing of the activity, be they individuals or organizations, singly or collectively, from responsibility and liability for any illness, injury, misadventure, harm, loss or inconvenience suffered or sustained as a result of the participation in the activity. I understand that in the event my child requires medical treatment while engaged in the activity, reasonable efforts will be made to contact my designated emergency contacts; however, if they cannot be reached, I hereby consent and give my permission to the PPC staff or any adult counselor acting on behalf of PPC with respect to the activity, to consent to any X-ray examination, medical, dental or surgical diagnosis; treatment; and hospital care advised and supervised by a physician, surgeon or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either as an outpatient or in any hospital. To the best of my knowledge, I have listed above all my child’s medical allergies, medications being taken, medical problems and other pertinent information. Finally, I agree that PPC may tape or photograph my child and record his or her voice during their participation in the activity. I agree that PPC will be able to use them, in whole or in part, whether in original or modified form in any manner or media, including without limitation, for the purpose of advertising, promoting, and publicizing PPC whether during the activity or thereafter. I hereby release and discharge Paoli Presbyterian Church and all affiliated entities from any and all claims, demands, or causes of action that I have in connection with the use and exercise of the rights granted in this release.
Parents Name: _______________________________________________________________________________________________ Parents Signature: ______________________________________________________________ Date: ______________________ Student Name: _______________________________________________________________________________________________ Student Signature: ______________________________________________________________ Date: ______________________ Please return this form, completed in its entirety, to the Director of Youth Ministries.
APPLICATION FOR HIGH SCHOOL Page 3 of 3 YOUTH MISSION TRIP 2016 – HILTON HEAD, SC – JULY 10-16, 2016
PPC Youth
KEEP THIS PAGE Important Dates
Payment Schedule: The total for the trip is $500, which covers the cost of everything except for gifts, souvenirs, and food on the drive there and back. As students work on fundraising, they will earn money toward their trip. If they do not participate in any fundraising then they will be responsible for the whole cost of the trip. The first $150 is non refundable unless someone else is able to take their spot on the trip. If a student makes enough money fundraising then the only cost to them and their families could be the $150 first deposit. There are Scholarships available for families that need help and the form for that is attached to the application. We will also be working with students to actively seek out support from family and friends. Fundraising will be limited this year to personal fundraising and not church sponsored. There will however be a special giving Sunday that will go toward the trip. Total discount will be added later on. 1.
Application and first payment of $150 is due on December 22nd (There are no exceptions. Our final numbers need to be turned in that day.)
2.
Second payment of $150 is due April 10th
3.
Third and final payment of $200 is due June 30th
Dates to Mark of Your Calendar: •
December 6th – 11:15am-12:15pm – Parent Informational Meeting - One is Mandatory
•
December 13th – 11:15am-12:15pm – Parent Informational Meeting - One is Mandatory
•
December 22nd – Midnight – Application Deadline
•
January 17th - 11:15am-12:45pm – Fundraising & Support Letter Help
•
April 10th – Second Payment is Due - $150
•
May 22nd - 11:15am-12:15pm – Parents meeting – Q&A
•
June 26th - 10:00am-11:00am – Mission Trip Commissioning Service – Mandatory
•
June 26th - 11:00am-4:30pm – Day away, mission team training – Mandatory
•
June 30th – Final Balance is due - $200
•
July 10th-16th – Mission trip to Hilton Head, SC
•
August 7th – 1:00pm-5:00pm – Reunion Pool Party – Location TBD
Hilton Head Mission Trip Scholarship Application Please fill in the application completely to be considered for a short-term mission trip scholarship. Financial information required will be held in strict confidence. Completing an application does not guarantee you will receive funds. Trip Destination ________Hilton Head, SC___________________ Trip Dates______July 10-16__________ Name __________________________________________________________________ Age __________ Street ________________________________City ____________________ State ________ Zip________ Home Phone _________________ Cell Phone____________________ Email_______________________ Paoli Pres. member? Attender? _________ How long have you been attending?_____________________ Why are you going on this trip, and what do you expect to gain from it?___________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Have you gone on a mission trip before? If yes, when and where?_________________________________ ______________________________________________________________________________________ Have you participated in a mission trip with another church? _____If yes, where did you go, with which church, and when? ______________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Have you put out a “support letter” to seek help from people you know? Have you received pledges of support? Please describe this effort._________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Total cost of trip?______$500_____________________________________________________________ Amount of support you anticipate from other sources?__________________________________________ Amount you expect to contribute from personal funds?_________________________________________ Amount requested from Paoli Pres?_________________________________________________________ Please be advised that Paoli Pres. provides scholarship help only for the mission portion of a trip. Any side trips for tourism or other purposes must be fully covered by the applicant. Signature of Applicant _______________________________Date of Application____________________
