TEAM REGISTRATION FORM

TEAM REGISTRATION FORM

Mail, fax or email this form to

Bethany Global Teams,

6820 Auto Club Rd. Suite O,

Bloomington, MN 55438

Fax (952) 829 2767 • Email

Phone (877) 783-6646 • (952) 996-1385

If mailing, enclose a check for your $75 registration fee made payable to “Bethany International.” If emailing or faxing your form, you can make the $75 payment online at https://secure.bethanyinternational.org/donate/index.php Under Donate to a Ministry, select Short Term Teams then enter your name and team number in the Comments box at the bottom of the page.

Trip information:

Country

Dates

Team #

1st Choice:

USA

June 21-26

182

2nd Choice:

CHOOSE ONE: ☒ I’m from the originating sending group/church ☐ I’m adding on to the sending group/church 1. Personal Information

Full Name:

(International teams – please enter your name exactly as it appears on your passport)

Name you prefer to be called by:

Permanent Address*:

Temporary/College Address*:

Alternative number: E-mail:

Occupation (title & description):

* Indicate which address you’d prefer for mailing purposes (please check the appropriate box)

Gender:

Citizen of (Country):

Age:

Birthplace (Country):

Birthdate:

2. Passport Information (INTERNATIONAL TEAMS ONLY)

If you already have a passport: attach a photocopy of the page that shows your photo and passport number. If you don’t yet have a passport: apply for one as soon as you can. When it arrives send a copy to the BGT office. Passport #:

Expiration Date: Country of Issue:

(Note – you can still send in your registration form even if you don’t yet have a passport. You can send us this information later)

3. Reference

Please list a character reference whom we may contact such as pastor/leader/employer; someone who will be easy to reach and will respond promptly to a reference request. This person should not be a family member.

Complete Name: Address: City: State/Province: Zip: Phone: Email:

How do you know this person?

4. Home Church Church Name: Address: City, State, Zip Phone:

Name of someone who knows you (eg pastor or staff member):

5. Why did you decide to sign up for this team? (What are you hoping for from this experience?)

7. Have you had previous experience on the mission field or traveled in a foreign country? If yes, please explain:

8. Foreign Languages

Please list any foreign languages you speak, if any. (Insert more rows if necessary)

Language Proficiency Level (Fluent, semi-fluent, reading, speaking only)

9. Name of person who will debrief with you after your trip (e.g. friend, spouse, parent)

10. What talents or skills do you have that the Lord can use on your outreach? Evangelism and witnessing:

Bible teaching: Health/Medical: Construction: Arts and crafts: Children’s Ministry: Music/Worship Leading:

Other (please list any other skills that could be helpful on a mission trip):

11. Please describe your health, including any allergies (to drugs, food, insects etc.) and any physical or dietary limitations that we should know about.

12. Are you on regular medication or currently under a doctor’s care? If yes, please explain:

13. Date of last tetanus shot and blood type:

In locations where the blood supply might be risky, we like to know team members’ types ahead of time. That way, if for any reason someone on the team were to need blood, it could be provided from within the team rather than from local blood banks. Medical personnel would double check blood types before performing any procedure. Last tetanus shot:

Blood type:

14. Emergency contact information Name:

Relationship: Daytime Phone: Nighttime Phone: Other form of contact:

15. Primary physician’s contact information Name:

Clinic: Phone:

16. If applicable, please indicate your parent-approved supervisor.

All team members under 18 must be accompanied by a parent-approved supervisor aged 21 or older. On inter-national teams parents need to designate a temporary guardian on the notarized Travel Authorization form.

17. I agree to abstain from alcohol, tobacco, and illegal drugs during this mission trip. Yes

☒

☐

18. T-shirt size

Each team member receives a regular t-shirt. If you would also like a collared golf shirt, please indicate below and add an extra $15 to your $75 registration fee for a total of $90. Note: Adult t-shirts are men’s sizes

Yes

☐

☐

Size: Size: Size:

Youth Small

☐

☐

☐

Youth Medium ☐ Adult Medium

☐

19. Is there anything else we should know about you?

20. Verification of Medical Insurance Coverage

Some health insurance policies cover short-term overseas travel; others do not. We recommend that you find out whether your current policy will cover you while on the mission trip for which you are applying.

Note that Bethany provides all international team members with emergency medical insurance coverage. If you’d like to know the details of that coverage, please contact us at the number above for a copy of the Bethany Global Teams policy.

Insurance Company: Phone #:

Address: Policy #: Group #:

21. Release of Liability and Release to Obtain Medical Care

MATTHEW 18:15-20 AND I CORINTHIANS 6:1-8 INSTRUCT US TO LIVE AT PEACE AND TO RESOLVE DISPUTES IN PRIVATE OR WITHIN THE CHRISTIAN CHURCH. I AGREE THAT THE LIMITED CHARITABLE RESOURCES OF BETHANY INTERNATIONAL SHOULD NOT BE DISSIPATED ON WASTEFUL LITIGATION. THEREFORE I EXPRESSLY WAIVE MY RIGHT TO FILE A LAWSUIT IN ANY CIVIL COURT OR OTHER SECULAR SETTING AGAINST BETHANY INTERNATIONAL AND OTHER ORGANIZATIONS AND INDIVIDUALS INVOLVED WITH THIS MISSION TRIP.

I HEREBY RELEASE ALL LEADERS AND ORGANIZATIONS INVOLVED WITH THIS MISSION TRIP FROM ANY AND ALL LEGAL LIABILITY FOR ANY SICKNESS, INJURY, OR DEATH THAT MAY OCCUR ON OR RELATED TO THIS TRIP. I FULLY REALIZE THAT THERE ARE HAZARDS, AND I AM KNOWINGLY UNDERTAKING THESE RISKS. I SPECIFICALLY RELEASE BETHANY INTERNATIONAL AND ALL CONCERNED FROM ANY CLAIM OF NEGLIGENCE IN THEIR DUTIES AS LEADERS ON THIS MISSION TRIP.

I FURTHER AGREE WHOLEHEARTEDLY TO ABIDE BY DECISIONS MADE BY LEADERS AND THOSE IN AUTHORITY AND BY ALL GUIDELINES, POLICIES AND RULES PERTAINING TO THIS TRIP. I UNDERSTAND THAT RANSOM AND EXTORTION WILL NOT BE PAID, NOR WILL BETHANY GLOBAL TEAMS YIELD TO OTHER DEMANDS ISSUED THROUGH THE USE OF HOSTAGE-TAKING. I HAVE READ AND AM IN FULL AGREEMENT WITH THIS RELEASE AND WAIVER, AND I UNDERSTAND THAT I AM:

 WAIVING ANY RIGHTS I MAY HAVE TO LITIGATE AND SUE  ACCEPTING BIBLICALLY-BASED MEDIATION TO RESOLVE DISPUTES

 ACCEPTING FULL RESPONSIBILITY FOR ALL MEDICAL COSTS AND ALL RISKS RELATED TO THIS TRIP  AUTHORIZING BETHANY INTERNATIONAL TO MAKE MEDICAL DECISIONS ON MY BEHALF IF NECESSARY  AGREEING TO ABIDE BY ALL GUIDELINES, POLICIES, RULES AND LEADERSHIP DECISIONS PERTAINING TO THIS

OUTREACH.

I CERTIFY THAT ALL THE INFORMATION I HAVE GIVEN ON THIS TEAM REGISTRATION FORM IS ACCURATE AND TRUE TO THE BEST OF MY KNOWLEDGE.

Applicant Print Name:

Signature: Date:

Parent/Legal Guardian (Parent or Legal Guardian signature for applicant age 17 or younger) Print Name:

Signature: Date: