TABLE OF CONTENTS
Why Partnership
2
The Partnership
3
Hispaniola Facts
5
Our Itinerary
6
The Cost
7
Necessary Steps to Take
8
Prayer Warrior Information
9
Who Is Eligible To Participate?
11
Common Questions
11
Expectations for Mission Participants
12
What to Take
14
Air Travel Regulations
15
Mission Trip Application
17
Medical Information and Release
21
Adult Release
23
Release and Indemnification Agreement
25
Team Agreement
27
Fundraising
29
WHY PARTNERSHIP?
When Jesus said to His disciples, “You will be my witnesses in Jerusalem, and in all Judea and
Samaria, and to the ends of the earth” (Acts 1:8), it communicated the scope of their ministry.
Not only were they to focus on their local countrymen, but they were to be a witness to their
region, the neighbor, and the rest of the world. At Northeast, we believe we have these same
responsibilities. Not only are we to be a witness in Rockford, but we are to look to be an
influence in our region and around the world.
The method we’ve chosen to accomplish this mission is partnership. We do not believe that
simply sending money is what our responsibility entails. We need to be financially invested in
these efforts, but we also need to be spiritually and physically invested in these efforts.
Instead of our knowledge of missions coming from slideshows or monthly newsletters, we
want every member of Northeast to understand missions through participation.
Participation in mission partnerships creates a few things:
1. It builds relationship. When you travel to visit one of our partners, we aren’t just there
to bring gifts and do work. These trips foster a relationship between our church and
theirs.
2. It brings understanding. Once true relationships are formed, we understand our
partner’s circumstances, their perspectives, their joys, their struggles, and their heart.
Knowing these things changes us. It changes the way we see our world.
3. It increases commitment. When we know our partners, it increases our desire to
support the work they do. In addition, when we understand their heart and see their
commitment, it inspires us to be more effective witnesses at home.
4. It provides mutual blessing. We have been blessed with an abundance of resources.
We are “rich” compared to the rest of the world. We desire to share that blessing with
others. But while they don’t have financial blessings to give us, we receive blessing in
witnessing their deep commitment to Jesus, from the depth of their prayer lives, and
experiencing their love for us.
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IT’S ABOUT RELATIONSHIP
Partnerships are about relationships. We want to know our ministry partners and we want
them to know us. This trip, this mission, is designed to accomplish relationship.
The problem, however, is that sometimes relationship building gets lost.
It is important that we do not allow the ‘mission’ to become the task we are doing. We can get
fixated on the work we are going to do or the project we want to complete. There can be a
tendency to measure the effectiveness of the trip by the amount of the work we get done.
But our primary task should be relationship.
It is also easy to allow the material blessing to eclipse the relational blessing. We can (and
have) radically changed the living conditions for the partners we serve. This can easily
become our focus if we let it. We need to/have to keep relationship building the primary task.
THE PARTNERSHIPS
By pursuing a relationship with national churches in two different countries, Northeast has
embarked on an exciting journey. We are partnering with a church in the Dominican
Republic and one in Haiti. The goal of our trip is to strengthen our relationship with Rafelito
and Lucne and the churches they serve. Here is what we know about the two churches and
their pastors.
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DOMINICAN REPUBLIC
Pastor
HAITI
Francisco “Rafelito” Garcia Rodriguez
Lucne Jean Pierre
Griselda
Daughters: Ruth and Noemi Doris
Son: Josue
Rafelito has a great heart. His wife is very
supportive and active in his ministry,
especially in the area of children’s ministry.
They currently rent an apartment in their
area of service.
Marie
Area
Served
Los Guandules
Phaeton
Detail
An area of intense poverty on the outskirts
of Santiago. This land is not deeded and
families live on top of each other on the
hillside surrounding a river valley. The area
is almost annually affected by flooding.
Phaeton is a fishing village on the northern
coast of Haiti. It is about two hours from the
border. The town has a population of
approximately 2000 people. The people
survive on fishing. Haiti is one of the least
developed countries of the world. Travel is
difficult due to very poor roads.
Past
Projects
We provide a monthly salary, which
enables Rafelito to concentrate on ministry
full-time. We have purchased a van for
their family to use both personally and for
use in ministry. Several years ago, we
completed construction of a church
building, which they used for various forms
of worship and a feeding center. We have
provided some teaching tools and training,
and have done a dental clinic.
We provide a monthly salary, which enables
Lucne to concentrate on ministry full-time.
We have recently increased his support in
order to expand a feeding program he runs
out of the church. We built a temporary
church building and have provided a
generator for lights. We also built a water
purification system and are completing
construction on a new church building.
Future
Projects
Building a house for Rafelito’s family.
Expanding the churches ministry in the
community, and possibly starting a school.
Complete the new
church/dormitory/feeding center on the land
that we acquired. Develop sustainable food
projects.
Photo
Spouse
Children
Personal
Detail
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Daughters: Nerline and Anjuola
Lucne pastors a congregation of about 200
people in Phaeton, a town on the northern
coast of Haiti.
H I S P A N I O L A
F A C T S
The Dominican Republic and Haiti share the island of Hispaniola. Hispaniola is the second
largest island in the Caribbean after Cuba. While the two countries may share the same
island, their cultures are vastly different.
DOMINICAN REPUBLIC
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Population: Nearly 8,800,000
Area is slightly more than twice the size of New Hampshire
Santiago is the second largest city with nearly one million people
Language: Spanish
Government type: Representative Democracy
Average Yearly Income: $5,600 annually per household
Industries: tourism, exporting sugar, coffee, tobacco
Unemployment Rate: 15%
Average life expectancy: 73 years
Currency: the peso-fluctuates daily
The year round temperature is 21 degrees C or 77 degrees F
The rainy seasons are from May-August and November-December
State Religion: Catholicism
HAITI
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Population: a little over 7,000,000
Language: French & Creole
Government type: Elected Government
Haiti is the poorest nation in the Western Hemisphere
80% live in abject poverty
The average annual income per individual is $240
50% unemployment rate
Average life span is under 50 years of age
50% of children die by the age of 5 (most due to the effects of malnutrition or disease)
80% of the population is illiterate
State Religions: Voodoo and Catholicism
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OUR ITINERARY
Departure Date: Tuesday, July 21, 2015
Return Date: Tuesday, July 28, 2015
We will leave Chicago on Tuesday, July 21. We will arrange for our airport transportation
once we assess the size of our team. We will either meet at the Van Galder terminal or
secure a private charter for our transportation. We will fly to Santiago, Dominican Republic
through Miami. In flight, we will be given immigration forms that need to be filled out. Your
team leader will have the necessary addresses for you to complete your forms. When we
arrive in Santiago, you will need to have your passport, your immigration form and $10 cash
ready. We will go through immigration, pay our $10 entry tax, get our passports stamped
and begin gathering our luggage.
IMPORTANT: We need to gather luggage in just one location. Once our entire group has
their luggage, we will proceed through customs. They may want to search your bags.
Representatives from G.O. Ministries will meet us at the airport and provide our
transportation.
Detailed itinerary information will be available as the trip approaches. This information will
be communicated at our team meetings prior to departure.
OUR TRIP WILL ENTAIL. . .
Partnerships: A key component of our trip is the deepening of the relationship between
Northeast and our partner churches. We will spend time getting to know the church at
Guandules and Rafelito. You should have several opportunities to have conversations with
them. We will have translators with us, so don’t waste the opportunity to love on them,
encourage them, and take an interest in their ministry.
Construction: There are ongoing construction projects on churches and medical facilities in
and around Santiago. We will participate in these as our schedule allows.
Children’s Ministry: There are a lot of children to serve in the community of Guandules. We
will participate in the daily feeding program and this will probably include a lesson time. We
will also do a children’s ministry event in Phaeton, Haiti during our day trip there.
Special Marriage Event: Northeast will be helping the Guandules church with a special
marriage event. This will include preparing a special meal, decorating, and serving at the
event. This idea is to transform the church into a nice restaurant in which we are the cooks
and waiters.
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Sewing Ministry: Create labels for various items that give biographical information about
the women who sew them. They will then be able to attach the labels to the products they
make.
Church Services: We will be attending at least one church service at Phaeton. Their service
is on Sunday evening. Please pack a pair of jeans or slacks and a collared shirt. Ladies are
welcome to wear dresses or skirts.
Beach Day: We usually spend our last night in the Dominican at one of the resort areas on
the north side of the island. We spend this 24 hour period debriefing from our experience,
getting hot showers, and souvenir shopping. There is usually an opportunity to do some
snorkeling and sunbathing as well.
THE COST
A non-refundable trip fee of $400 will be collected from each team member. The remainder
of the trip expenses will be raised as a team. The team fundraising goal will be determined
once the team is solidified. There will be a minimum expected fundraising goal and everyone
is expected to participate.
Expenses for this trip include:
Transportation, lodging, food, border crossings, and expenses for the missionaries and
nationals that will be working alongside us.
Out of pocket expenses not included in the above include:
• Immunization costs
• Fees to obtain passport
• Meals in route (Airport food is expensive!)
• Spending money (For souvenirs, snacks, etc. – Plan for at least $50)
• Tourist card and exit card ($10 cash – US)
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NECESSARY STEPS TO TAKE FOR
THIS MISSION TRIP
1. Pray
Does God want to stretch me and teach me? Am I willing to participate in the
promotion of Northeast’s partnerships? Am I spiritually where I need to be to
participate in a “mission” representing the Lord?
2. Complete and Turn in the Application Form & Trip Fee of $400
Deadline: Sunday, March 29
Forms can be turned in to the main office prior to March 29.
3. Apply for Your Passport
Passports are required to travel to the Dominican Republic and Haiti. Please allow 46 weeks for your passport to arrive. You can expedite the process, shortening the
process to three weeks, but you will pay an extra $60 to do so. To obtain a passport,
you need a certified copy of your birth certificate, two passport photos (available at
Walmart or Walgreen’s), and a driver’s license. You can get passport forms at the Post
Office on Harrison Avenue. The cost is $135 for a first time application for adults and
$105 for individuals under the age of 16. It is $110 for a renewal. Your passport is
good for 10 years. More information is available at:
travel.state.gov/passport/passport_1738.html.
4. Get Your Shots
You must have an up-to-date Tetanus/Diphtheria vaccination. For the latest
recommended vaccinations, check with the Center for Disease Control. Their
website is wwwn.cdc.gov/travel/default.aspx. You can also call them at 404.332.4559
or the Winnebago Health Department at 815.962.5092.
5. Turn in the Necessary Forms and Payments
Turn in the following to Laura Anderson in the office.
Due Sunday, March 29
• Application Forms
• $400 non-refundable trip fee
Due at the Second Meeting
• Individual Short-Term Mission Trip Agreement Form
• Medical Authorization and Information Form
• Adult Release Form
• Adult Medical Information Form
• Adult Release and Indemnification Agreement (For adults and minors)
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Due at the Final Meeting
• Passports turned in for copies and safekeeping
6. Begin the Discipline of Daily Journaling
This is to record your daily thoughts and observations. It is where you can begin to
record what God is teaching you and see areas of your life that He wants to change.
Some topics might include…
• Yesterday…
• What I expect from this experience….
• My first impressions of the Dominican/Haiti are…
• I saw the most incredible thing today…
• Let me tell you about who I met today…
• God, I can sense you teaching me this…
7. Recruit 3 Prayer Warriors
See page 10 for more details.
8. Take Part in our Mission Trip Meetings
We will be meeting to discuss our responsibilities, what is expected of us, and to work
on the skills necessary to be effective. These meetings are mandatory for all
participants. Meetings will take place at Northeast or at the home of Wayne & Angie
Hume. We will have additional meetings that will be announced as needed.
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PRAYER WARRIOR INFORMATION
A prayer warrior is someone you choose to pray for you. They agree to faithfully pray that
you will be able to serve God with strength and love, and that you will be taught and
stretched in your faith and strengthened in your relationship with Christ.
The prayer warriors will pray for you in the weeks before the trip that God would be
preparing you for this mission experience. They should pray that God would provide the
financial needs of both yourself and the mission team. The prayer warrior should also pray
during our weeklong spiritual adventure. They need to be praying for your protection, that
God would use you, and transform you.
These prayer warriors are a vital part of this experience. They will determine the success of
our trip. God is the only one who can make this trip possible. We must recognize our
dependency on Him.
These prayer warriors are going to keep Satan out of our way. Undoubtedly, Satan will try to
discourage us. Our support team will be fighting a spiritual battle for us that we might do our
best.
Steps in Asking for Prayer Warriors
1. Think of several people who you know would pray for you during your experience.
They could be elders, teachers, parents, friends, or other church members. Do not
choose someone who has been asked by another team member. One person can be
from within your family, but choose the other from outside your family.
2. Contact them and explain to them what we will be doing, where we are going, and
why you are going.
3. Ask them if they would take the challenge to pray for you daily as we prepare to go
and especially pray during our trip.
4. Give them something to remind them of their commitment. Make a card or something
they can hang on their fridge. People will need a reminder.
5. Thank them for going to the Lord on your behalf. Thank them for investing their time
in you. Thank them for helping your relationship with the Lord grow so that you may
live a more committed life.
Name three prayer warriors whom you have enlisted to pray for your experience.
Name ________________________________________________ Phone Number__________________________
Name ________________________________________________ Phone Number__________________________
Name ________________________________________________ Phone Number__________________________
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WHO IS ELIGIBLE TO
PARTICIPATE?
1. Those who have a personal relationship with Jesus and have accepted Him as their
Lord.
2. Those who have a servant’s heart, willing and able to serve and help people, as well as
teach.
3. Those who want to be challenged to a higher level of commitment and a deeper, more
personal relationship with Jesus Christ. We need those who are serious about their
growth in the Lord.
4. Individuals with good character, above reproach, able to be taught, and able to follow
complete instructions.
5. Those who are faithful and active in our church’s ministry.
6. Those who are serious about the trip as a way to grow in the Lord, not as a fun week
away from kids, work, or an opportunity to improve the tan.
7. Those who understand that if there are any conduct or attitude problems, they could
be sent home. Ticket departure dates are easily changed.
COMMON QUESTIONS
Where are we staying?
While in the Dominican, we will be staying in a dormitory facility in Santiago in the barrio
known as Hoya del Ciamito. It has beds, showers and toilets.
In Haiti, we will be staying at the church building. It has 3 new outdoor shower stalls and a
new bathroom with a flush toilet! We will be sleeping on foam pads on a concrete floor or in
tents. The conditions are crude and space for changing clothes and storing belongings is
limited.
What about our food?
The dormitory in the Dominican has a dining hall where our meals will be prepared.
In Haiti, we will eat at Lucne and Marie’s home. The meals are prepared safely. They will
feature traditional Haitian foods…mainly fish, chicken, eggs, rice, beans, some veggies and
possibly bread.
All food (whether in the Dominican or Haiti) is prepared with purified water and safe water
will be available for us to drink throughout the trip.
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It is important that we not refuse to eat or be reluctant to try something new. Their recipes
are mild in seasoning; however some of the fruits and vegetables are not normal for us. Try
it!
Will the people speak English?
In the Dominican, many of the young people can speak some English.
Few of the Haitians speak broken English. Some can speak Spanish. Most know some French.
The native language is Creole, which is a mix of French and African languages. They enjoy it
when we try to communicate in their native language.
What will the weather be like?
Hot. Expect temperatures to be in the 90’s and the humidity to be high.
How much money do I bring?
You will need money for extra things, such as cokes or souvenirs. Bring cash, not traveler’s
checks or credit cards. We will try to let you know exactly what you’ll need prior to the trip.
Meals are included in the price of the trip except for our trips to ice cream shops or
restaurants. You will need $10 for entry taxes and any additional expenses as we travel from
Chicago to Santiago.
We will exchange money when we arrive in the D.R. The exchange fluctuates, but was
recently as high as $1 U.S. = $37 pesos. You should plan on exchanging at least $20-$40. You
can exchange more if you plan to spend more. There is really nothing to buy in Haiti, but we
will do some souvenir shopping in Santiago or on our beach day.
What about sending a message?
Calling out: While in Haiti, you may be able to send texts back to the U.S. if necessary.
The cost is .50 to send/.05 to receive. Calls are more expensive and should only be made in
emergency situations.
Calling In: The emergency contact number in the D.R. is 1.809.961.8100 or
1.829.404.6724. This is for emergencies only! They will be able to get a message to us.
EXPECTATIONS FOR MISSION
PARTICIPANTS
The most important thing to remember on any short-term mission trip is that you are there
to serve, not to be served. You are there as an invited guest. Encourage each other to have
the attitudes and actions of a guest, which include being courteous, being polite, having good
manners and being thankful.
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The American culture is very different from other cultures. One of the main differences is
our freedom to “just be ourselves”. This is often offensive in other cultures. James Downs
said, “One of the greatest stumbling blocks to understanding other peoples within or without
a particular culture is the tendency to judge other’s behaviors by our own standards.” It is
extremely important to sit back and take in the culture you are part of without giving into the
temptation to want to change it and make it like your own.
While many nationals may not understand everything you say, they are watching everything
you do. That includes every face you make, laugh you give, or gesture you may think no one
saw. Remember that you represent Christ and allow your attitudes and actions to reflect
that.
Dress – Modest dress is appropriate at all times, especially on the Dominican side. In Haiti,
people wear what they have and sometimes that isn’t much. Shirts and shorts are
appropriate most of the time.
Attitude – Your attitude should always reflect Christ.
Participation – You are expected to participate in all team activities and projects. You should
be on time to all meals, meetings, and the beginning of the work projects.
Cultural Expectations – Even though the Dominican and Haiti are not geographically that
far from the U.S., there are some cultural differences that we are expected to follow.
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Do not flush toilet paper. It goes in the trash can next to the toilet.
Do not spend too much time talking with someone of the opposite gender.
Don’t ask personal questions until you have established a friendship of trust.
Do not give money to nationals. We support them through G.O. Ministries. Arrange
any gifts to nationals through their staff.
Eat whatever you are served. Don’t ask for items not on the table.
Do not drink anything out of a faucet. Do not drink anything you are unsure of. This
includes water you may use when brushing your teeth.
Please refrain from smoking and alcohol consumption. We may see freedom in these
areas, but most of the Christians of Hispaniola do not.
Do not whine or complain. It’s unbecoming as a Christian and it almost never helps the
situation.
Do not try to be macho and work yourself to exhaustion. It will be hot, so drink lots of
water, rest in the shade, and use plenty of sunscreen.
Do not forget to wash your hands before every meal or snack.
Leave sarcasm at home. This is sometimes how we release our frustrations with our
team members, however, it can be easily perceived as a put down to nationals.
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WHAT TO TAKE
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Passport
Airline ticket
Work Clothes (jeans, cotton
shirts/T-shirts, shorts)
Swimsuit (One piece)
Shoes (work shoes, tennis shoes,
flip flops)
Hat or bandana
Work gloves (Mechanics gloves)
Towel/Washcloth (2)
Toiletries
Ibuprofen, Imodium, Dramamine
Chap stick
Aloe Vera, sun burn treatment
Hand Sanitizer
Flashlight
Light Sleeping bag and sheets
Pillow
Sunscreen
Insect Repellant (non-aerosol)
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A personal water container with a
wide top
Snack Food
Bible/Journal/Pen
Camera (extra batteries)
Plastic bags for dirty clothes (2)
Contact wearers: A back-up pair of
glasses
New or gently used clothes to give
away
Nylon cord for hanging clothes
Spending money ($50-$100)
Ear plugs
Alarm Clock (battery powered)
Sunglasses
Some sort of strapped sandal or
aqua sock for the beach in Phaeton
Full leather work gloves
Mosquito Net
WHAT NOT TO TAKE
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Expensive Jewelry
Portable electronics that may prove to be a distraction to you. Do not isolate
yourself!
SPENDING MONEY
We would recommend $50 to $100. It all depends how much you want to spend on
souvenirs. You can get by with less. Do not buy large souvenirs, or ones difficult to carry or
they will be staying on the island. Remember that you will have a few snacks and possibly a
meal out while in the DR. Plan on having enough money for that. Another consideration is
your meals on the way there and on the way home.
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AIR TRAVEL REGULATIONS
Arrival Time
Due to heightened security measures, you will need to allow more time for check-in, security
screening and boarding. American Airlines advises airport arrival two to three hours before
for international flights depending on your departure airport. Have your passport and ticket
with you at all times.
Baggage Guidelines
Carry-ons - When packing, please remember that new Federal carry-on rules allow one
standard-size carry-on bag and one personal item such as a purse, laptop computer, small
book-type backpack or briefcase. Bring only what you can personally handle. Airports
recommend packing your film in your carry-on. We suggest packing a couple days worth of
needed items (toiletries, work clothes, gloves, etc.) in case your checked bags are lost for a
few days. Certain items cannot be packed in carry-ons, including:
• Knives of any length.
• Cutting instruments of every kind (metallic or non-metallic), including carpet knives,
box cutters and other folding or retractable blades.
• Items such as ice picks, straight razors, elongated scissors and knitting needles.
• Liquids or gels in your carry on need to be in a one quart plastic Ziploc bag and they
cannot be containers of more than 3 oz.
Checked bags - Please limit luggage to a maximum of two large, sturdy duffle bags or
suitcases (50 lbs. a bag). Make sure you only bring what you can personally handle. Make
sure your name and contact information is on the outside and inside of each bag. Coming
back from the DR, they hand check your checked luggage and you will not be able to pack any
aerosol items or items containing alcohol. New Federal security rules require customers who
have checked baggage to fly on the same flight as their checked bags. You might consider
putting shampoo or other liquids in Ziploc bags for traveling as these sometimes leak on
airplanes.
Security Checkpoints
Have your ticket and passport ready to enter the security checkpoint. Only customers with a
valid government-issued photo ID and ticket will be able to pass the checkpoint. Passengers
should be prepared to have their carry-on items thoroughly searched. If you have packages,
such as gifts, they should be unwrapped because they will be subject to inspection. Random
passengers will be checked with an electronic wand and then patted down by airport
security employees. Some may even be asked to remove their shoes to put through the
scanning machines. Please prepare your team for these actions and encourage them to take
these matters seriously.
At the Gate
New safety checks require passengers to be at the gate an hour prior to departure.
Passengers will be asked to show a passport and ticket to board. Due to random security
screening, be prepared again to have carry-on baggage hand checked and to be patted down
and screened with an electronic wand before boarding.
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SHORT- TERM MISSION TRIP
APPLICATION
Due by Sunday, March 29 - Please enclose the trip fee of $400
PLEASE PRINT
Legal Name (as it appears on your Passport):
__________________________________________________________________________________________________
(First)
(Middle)
(Last)
Address: _________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
E-mail Address: _________________________________________________________________________________
Home Phone: _______________________________
Place of Birth: _____________________________
Gender: Male / Female
Work Phone: _______________________________
Date of Birth: __________________
Age: ________
Marital Status: Single / Married / Divorced / Widowed
Have you accepted Jesus as your personal Lord and Savior and been immersed into Him?
Yes __________
No __________
Do you have a criminal record? ________ If yes, please explain:
T-shirt size (circle one):
S
M
L
XL
XXL
If under 18 years of age
Name(s) of parent(s) or guardian(s): ____________________________________________________________
Occupation
Please describe your present employment and any pertinent talents you have regarding
work experience related to missions. ___________________________________________________________
__________________________________________________________________________________________________
Language
Being fluent in Spanish is not required, however, please list any training you may have had in
the language. Number of years ____________ Fluency __________________________________________
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Skills & Talents
Please check any skills or talents you may have. For areas you are professional in, please
write PROF.
Construction
______ Carpentry
______ Painting
______ Electrical
______ Plumbing
______ Other________________________
Business
______ Computers
______ Accounting
______ Other_________________________
Sports
______ Basketball
______ Baseball
______ Soccer
______ Softball
Children’s Ministry Experience
______ Teaching Ages: ____________________
______ Vacation Bible School
______ Crafts
Medical
______ Nursing
______ Physician
______ Dental
______ E.M.T.
______ Therapy
______ Other _________________________
Music
______ Instrument ___________________
______ Vocal
______ Other _________________________
Other Performance
______ Drama
______ Clowning
______ Puppetry
______ Other __________________
Other Skill or Talent: __________________________
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Describe your personal relationship with Jesus.
How have you served God in the last twelve months?
Why do you want to go on this mission trip?
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What are your strengths and weaknesses?
What do you expect God to teach you through this mission experience?
Signature: _________________________________________________________ Date: _______________________
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MEDICAL INFORMATION & RELEASE
Name ___________________________________________________________ Birth Date ___________________
Address _________________________________________________________________________________________
City ___________________________________________________ State _____________ Zip _____________
Home Phone _________________________________ Work Phone _________________________________
Medical Insurance Provider ____________________________________________________________________
ID# ___________________________________________ Group# ______________________________________
Name of Primary Physician _________________________________________ Phone __________________
Address _________________________________________________________________________________________
City ___________________________________________________ State _____________ Zip _____________
Emergency Local Contact _________________________________ Relationship ____________________
Address _________________________________________________________________________________________
City ___________________________________________________ State _____________ Zip _____________
Home Phone _________________________________ Work Phone _________________________________
Please check if you suffer from any of the following medical conditions:
__ Hypertension
__ Seizures
__ Arthritis
__ Migraines
__ Hypoglycemia
__ Insect Allergies
__ Diabetes
__ Bleeding Disorders
__ Asthma
__ Depression
__ Heart Disease
__ Chronic Anxiety
__ Glaucoma
Physical limitations – Please list ________________________________________________________________
__________________________________________________________________________________________________
List any medications (prescriptions or OTC) taken on a regular basis _________________________
__________________________________________________________________________________________________
List Medical & Food Allergies __________________________________________________________________
__________________________________________________________________________________________________
Blood Type _____________ Have you had any surgery in the past three years? __________________
If so, please explain _____________________________________________________________________________
__________________________________________________________________________________________________
In an emergency, I give my permission to a licensed physician to hospitalize or anesthetize
me, 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 ____________________________
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ADULT RELEASE
Knowing and understanding the risks and situations involved in participating in a mission trip
to the Dominican Republic and Haiti from the dates of _________________ to _________________, I
do hereby release, acquit, and forever discharge Northeast Christian Church and its
representative, agents, administrators, officers, directors, elders, and assignees from any and
all liability now incurred or hereafter incurred on account of any and all claims or causes of
action which I now have or may hereafter have for personal injuries, loss of services, medical
expenses, losses or damages of any and every kind or nature whatsoever, now known or
unknown or that may hereafter develop from known or unknown conditions, diseases,
sickness, injuries sustained or received between the dates of ____________________ through
__________________, through participation in a working mission trip to Dominican Republic and
Haiti and surrounding areas. I do hereby declare that I fully understand the terms of this
agreement and release, that I have carefully read the foregoing document and know the
contents thereof, and I intentionally sign the same on my own free will.
Signature _____________________________________________________ Date ___________________________
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RELEASE AND INDEMNIFICATION AGREEMENT
In consideration of the undersigned’s participation in a mission trip facilitated by G.O. Ministries, Inc. of Jefferson County,
Kentucky, Inc. (the “Organization”) and as an inducement to facilitate the mission trip and permit the undersigned’s
participation therein, the individual, (the “undersigned”) agrees as follows:
The undersigned hereby fully and forever releases and waives and agrees not to cause to be brought any and all claims,
demands, actions, or causes of action of every possible kind and nature whatsoever the undersigned might assert, including,
without limitation, claims for personal injury, wrongful death, or property damage, whether or not absolute, known or
unknown, or otherwise against the Ministry or any of its Directors, officers, employees, agents or volunteers (collectively
referred to herein as the “Ministry”) by reason of, arising out of or relating to the undersigned’s participation in a mission
trip.
The undersigned further agrees to indemnify, defend and hold the Ministry harmless from damages, including, without
limitation, special, incidental and consequential damages, losses or expenses suffered or paid, directly or indirectly, as a
result of any and all claims, causes of actions, suits, proceedings, demands, judgments, assessments, and liabilities, including
reasonable attorneys’ fees incurred in litigation or otherwise, assessed, incurred or sustained by or against the Ministry by
reason of, arising out of or relating to the undersigned’s participation in a mission trip.
The undersigned further agrees that this Release and Indemnification Agreement (the “Agreement”) is binding upon the
undersigned’s heirs, executors, administrators, assigns and legal representatives; that this Agreement releases all
successors, assigns and legal representatives of the Ministry; and that this Agreement is to be governed by the laws of the
Commonwealth of Kentucky.
The undersigned further agrees that the execution of this Agreement is continuing in nature; it is the undersigned’s
knowing and voluntary act; the undersigned does not intend to participate in the mission trip until and unless the
undersigned has had full opportunity to the undersigned’s satisfaction to inspect and determine the scope of the mission
trip and receive all information which bear on the undersigned’s decision to participate; and the undersigned is under no
duress or undue influence to execute this Agreement.
The undersigned hereby grants full permission to the Organization to use any photographs, videotapes, motion pictures,
recordings, or other records or documents of the mission trip and to do so without notice or compensation to the
undersigned.
The undersigned acknowledges that the Organization has made available applications for travel insurance
and agrees that it is the undersigned’s responsibility to purchase travel insurance.
The undersigned assumes responsibility for full payment of the published and announced cost of the mission trip; agrees to
pay any outstanding balance upon request by the Organization; and agrees that any and all cost incurred by the
undersigned during the mission trip, including, without limitation, costs due to health problems, emergencies and death, are
the responsibility of the undersigned or estate of the undersigned.
The undersigned acknowledges that the undersigned has read and understands this Agreement; that the undersigned has
not relied in signing this agreement on any statement, oral or otherwise, by the Organization or its officers or employees;
and that it is the undersigned’s intention with this Agreement to make a complete, general and unconditional release of any
and all claims whatsoever against the Ministry as set forth above.
IN WITNE SS WHEREOF, the undersigned hereby executes this Agreement on the date set forth below.
If under 18 years old, you must sign and in addition have a parent or legal guardian sign as well.
Signature _________________________________________________________________________________________________________________________
Printed Name ___________________________________________________________ Date __________________________________________________
Parent/Guardian Signature ______________________________________________________________________________________________________
Printed Name ___________________________________________________________ Date __________________________________________________
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TEAM AGREEMENT
As a member of this team I agree to:
1. Remember that I am representing Jesus Christ and will model Jesus in my behavior and
attitude.
2. 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 you feed me I will swallow.”
3. Remember that we have come to learn as well as to teach. 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.
4. Respect the host’s view of Christianity. I recognize 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.
5. Develop and maintain a servant attitude toward all nationals and my teammates.
6. Respect my team leader(s) and his or her decisions.
7. Refrain from gossip.
8. Refrain from complaining. I know that travel can present numerous unexpected and
undesired circumstances. Instead of whining and complaining, I’ll be creative and
supportive.
9. Attend all team meetings before the trip and well as any follow-up meetings.
10. Remember not to be exclusive in my relationships and interact with all members of the
team.
11. Refrain from any activity that could be construed as romantic interest in a national or
teammate.
12. Remember that I can be sent home if I do not adhere to this agreement or if my Team
Leader believes it is in my best interest or that of the team.
Signature ________________________________________________________ Date_________________________
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F U N D R A I S I N G
Building a Support Team
A common mistake about raising funds for a mission trip is believing it is only about the
money.
It certainly is about money, but it is also about building a partnership with supporters. Paul
says, “I thank God every time I remember you. In all my prayers for all of you I always pray with joy
because of your partnership in the gospel from the first day until now.” Philippians 1:3-5
When someone agrees to support you, include them in your mission experience. Remember
to send a thank you card before the trip and send a letter about your trip afterwards to
follow-up.
Letter Writing
We have found that the best way for raising funds for a trip is through letter writing. In order
to do that, we often must push aside our pride and let others in to help us - remembering that
they will become a part of your trip through supporting the mission’s team.
Make a list of family members, friends, and church members, who may be interested in
supporting the team. Write a letter including:
• What your trip entails.
• Explain the purpose of your trip.
• Give details of how God has led you to this trip.
• Give instructions to send any gifts to Northeast by July 1. Make checks payable to
Northeast Christian Church.
• Explain why you chose to participate.
• Tell the reader of planned activities.
• Explain the need.
• Ask the reader for specific actions based on the need.
Remember that people give to short-term missions when they feel informed, when they
believe their gift will change lives, when they feel like they are an important part of the trip
and when they sense your enthusiasm about it.
How Much Can I Raise?
Our past experience with fundraising letters has been good. We have seen God provide in
ways that we initially could not have imagined.
As stated earlier in this packet, you are responsible to pay the initial $400 trip fee. Then as a
team, you will raise the remainder from outside donations through the use of fundraising
letters. We will then get you a list of those who gave specifically to you so that you can send
out thank you letters.
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S A M P L E
F U N D R A I S I N G
L E T T E R
The following is an example of a letter that was successful
Dear John,
I hope this letter finds you well. I have been great and I have some exciting news to share
with you. I have the opportunity to travel to Haiti with Northeast Christian Church from July
21-28, 2015.
During the week, our team will be helping our sister church in Santiago, DR by developing a
special marriage ministry for the community, serving in a daily feeding program, and helping
with a program that teaches women how to sew and sell what they make for income.
In order to make this possible, I need to assemble a sponsorship team. People like you who
can sponsor our team and/or who would be willing to lift us up daily in prayer as we seek to
serve God in this area. The total amount we need to raise as a team is ______________. This
amount includes travel expenses, food, lodging, supplies and equipment that we will leave for
the Haitian people when we return home.
I would appreciate your prayerful consideration of giving financially to meet this need. Our
deadline is July 1, 2015. All gifts are tax deductible and your check needs to be made payable
to Northeast Christian Church. I have enclosed a return envelope for you to mail
contributions directly to Northeast.
I know that there are many opportunities each year to support these types of outreaches.
So, if you have already financially contributed, please do not feel obligated to partner again in
this way. But, may I ask that you do mark your calendar to pray for this trip?
If you have any questions or would like more information about the trip, please do not
hesitate to call me. Thanks so much for your support and consideration. God bless you!
In His love,
Sarah James
.....................................................................................................................................................................................................
Please return with your gift
This Gift is to Support the team going to the Dominican Republic July 21-28, 2015.
The letter I received about the trip was from ___________________________________________________
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