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Mission Trip Registration

Dominican Republic 2019

A minimum deposit of $800.00 is required unless a scholarship arrangement has been approved.

11/3/2019 - 11/9/2019
$1,300.00

Additional Information

Please fill out the below form.
*Do you have a passport?:
*First Name as shown on passport:
Middle Name as shown on passport:
*Last Name as shown on passport:
*Suffix as shown on passport:
*Passport Number:
*Expiration Date:
KTN #:
Global Entry #:
*Gender:
*Date of Birth (mm/dd/yyyy):
*Emergency Contact Information #1 (List Name, Relationship, and Phone #)
Emergency Contact Information #2 (List Name, Relationship, and Phone #)

Health Insurance Information

*Health Insurance Provider:
*Policy and/or Group Number:
*Full Name of the Insured:

Medical History

List any medical restrictions/disabilities:
List allergies (including food):
Date of last tetanus shot:
*Are you pregnant?:

Personal Development

Why do you feel called to service through this mission opportunity?:
How do you hope to grow spiritually through this mission service opportunity?:
Please describe past mission service experience (may be volunteer activities at a local level in addition to mission trips):
Are you willing/able to commit to pre-trip spiritual preparation with others prior to departure? Please note conflicts:
Please provide name and contact information for a pastoral reference (phone and email):
If you are not an active participant at First Presbyterian Nashville, please indicate the best time/s for a phone interview.

Team Covenant

I will be open to the leading of the Holy Spirit as I practice flexibility when even the best laid plans go awry. For the days of this trip I will seek to follow the example of Jesus who did not come to be served, but to serve.

I will honor the foreign cultural context in which we will be serving by practicing gratitude for the food we are served, welcoming different expressions of Christian worship joyfully, dressing with extreme sensitivity to the standards of dress of those we are serving, and showing compassion for the economic situation of the people we are serving by only spending money that is consistent with the overall behavior of the group.

I will be a team player and respect the trip leadership recognizing that team morale is more important than any one individual’s personal preference or pleasure. In the interest of safety and the furtherance of team building, I will be present at all scheduled group activities. Furthermore, during both work and leisure times, I will remain in the area of other group members unless prior permission is granted from the trip leader.

As a member of a Christian community, I recognize that I represent FPC-Nashville at all times and will be especially attentive to the impression my actions and words have on those around me. I will respectfully limit political discussions that reflect negatively on any country.

I will refrain from language and conduct that may be offensive to the community I am visiting. I will refrain from the consumption of alcoholic beverages whenever there are minor children present, while on the job site, any time while riding in a vehicle, and anytime I am a driver of any vehicle rented and/or driven on behalf of the church.

The signature below affirms that this covenant is committed to by :
*Digital Signature 1 (First, Middle Initial, Last):
If participant is a child or youth, parent signature is requested below:
Digital Signature 1A (First, Middle Initial, Last):

Trip Cost and Member Agreement

The trip cost is payable to First Presbyterian Church. I agree to fulfill all financial requirements in accordance with the payment schedule established for this mission service opportunity and if my personal circumstances change, I agree to notify the Missions Office immediately to make alternate arrangements. I understand that my failure to provide necessary documents and payments as agreed could affect my ability to participate in this mission service opportunity. All or a portion of my payment is considered a donation and if I cancel the trip the funds may not be refunded. If for some reason FPC has to cancel the trip all payments will be refunded.

By signing below, I agree to the above terms and understand that completing this form does not guarantee my participation as a member of the mission team for which I am registering.:

*Digital Signature 2 (First, Middle Initial, Last):

 

Financial Assistance

If you need financial assistance, please contact Sandra Randleman, 615-298-9502, or srandleman@fpcnashville.org.:

Questions?

I you have questions regarding the trip, please contact Annette Crout, 615-298-9507, or missions@fpcnashville.org.
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