GO TEAM APPLICATION

If you are interested is going on an upcoming trip, the first step is to fill out the following application.

GENERAL INFORMATION

Name as it appears on your passport

Address

City, Province, Postal Code

Home Phone

Cell Phone

Work Phone

Gender

Date of Birth - dd/mm/yyy

Occupation

Home Church

Language fluency other than English

Emergency Contact Name

Emergency Contact Number

MEDICAL INFORMATION

Other

Please explain any limitations, restrictions, or required treatment of the above conditions.

Are you currently taking any prescription medications?

Yes No

If you answered 'yes' to the previous question, please list the dosage.

*Make sure you bring all necessary medications for the duration of the trip and have them stored in original containers.

ALLERGIES

*If you have a life-threatening allergy, it is recommended you carry an Epi-Pen and wear a Medic-Alert Bracelet.

Do you have any allergies

Yes No

If yes, please list any allergies you have and what you use to treat them.

Do you require a special diet?

Yes No

Have you ever received treatment for drug/alcohol depencency?

Yes No

If yes, please submit details below.

Medical Disclaimer

For personal reasons, I choose not to include personal medical information. I understand the risk of not communicating this information with the team leader and Grindstone Church and release from any lawsuit claim that may come as a result of not sharing this information. (Team members who do not include the medical information may not be accepted on a team.)

Please check all immunizations you have acquired previously.

Other

Please list the dates the above immunizations were acquired.

Immunization Disclaimer

For personal reasons, I have not participated fully in the immunization program as outlined by the Public Health Agency of Canada. I release Grindstone Church from any lawsuit or liability claim that may come as a result of not being immunized. (Please note that some countries will not allow visitors entry without certain shots. Team members who cannot receive required immunizations may not be accepted on a team.)

EXPERIENCE

Tell us about yourself (e.g., education, work experience, strengths/weaknesses, goals, passions, spiritual gifts, special talents, etc.)

State briefly why you are applying for this mission trip, and any personal expectations you have for the trip.

Work/Volunteer exprience or mission experience that may prove to be beneficial for this trip.

Current or previous involvement in Grindstone ministry and outreach.

PARTICIPANT AGREEMENT AND CHILD PROTECTION

Participant Agreement

If I am selected for the team, I will make every effort to: - Be other-centred, cooperative, and submit personal desires and preferences (privacy, food, dress, etc.) to standards of the host - Follow and adhere to Grindstone Church policies and procedures as presented by my team leader(s) and host - Be committed to fully participate in team meetings, debriefs, and re-entry training - Participate in all team support raising/fundraising efforts

Child/Youth Protection: Assault and abuse issues are important in our society today. During this short-term team's work, we may be placed in positions of responsibility for children and other vulnerable members of society. We ask everyone who applies for a short-term team to answer the following questions.

Have you ever been convicted of a criminal offence for which a pardon has not been given?

Yes No

Have you ever been investigated by the Children's Aid Society regarding any kind of abuse of children?

Yes No

Have you ever emotionally, physically, or sexually abused another person?

Yes No

If you answered 'yes' to any of these three questions, please give details below or in dialogue with the team leader.

I have provided my current police check (completed within the last 12 months) to the team leader or the Go Team.

Yes No

If accepted to the team, I may be required to have additional supervision as deemed necessary while on the team.

Yes No

RESPONSIBILITY/PARENTAL RELEASE FORM

Complete this section only if short-term missionary is 18 years of age or older.

I hereby delcare that I/we will not hold Grindstone Church responsible for my/our death or any accident which may occur during my service with this organization. I/We absolve all rights to claim from this organization any remuneration in case of ill effects resulting from this trip. I/We undertake this trip at my/our own risk with the understanding that Grindstone Church is not responsible for my/our welfare.

Complete this section only if short-term missionary is under 18 years of age.

I/We do hereby give my/our permission for him/her to participate in the team in accordance with the terms outlined in the section above.

Name of Dependant

Relation to Dependant

Your Name and Date

*If you are under the age of 18, your parent/guardian must complete a notarized parent letter. Please talk to your team leader or a member of the Go Team to get a copy of the letter to be notarized.

PHOTO WAIVER

By participating in this short-term mission opportunity, I consent to the use of my photograph, without compensation, in any future publicity carried out by Grindstone Church.

By submitting this application I understand that the trip does not just include the actual time away at Muskrat Dam but that I must attend all pre-trip training sessions, team fundraising events, and the debrief following the trip, as each part holds value for not only my own trip experience but benefits the team as a whole. If I cannot commit to all parts of the trip I may not be selected or allowed to continue on with the team.

Yes No