21632_Student Missions Application

2015 Student Missions Application
Office Use
Only
I have included
this
Name:
Application with all questions fully answered/ signed
Mission Trip Agreement
Completed Parent Reference Form
Completed Personal Reference Form
(This can be turned in separately, but must be in by
January 4, 2015)
Completed 2015 Medical Authorization form (new forms required every
January.)
Copy of Insurance Card
Copy of Photo ID
Deposit Check #
Over-the-Counter Medication Authorization (Optional)
T-Shirt size
Complete application at: benttree.org/families/student-missions
I confirm that I have included all of the items above.
Signature
Office Use Only
I confirm that all of the items above have been received.
Signature
Incomplete applications will not be accepted. Late applications will be put on a waiting list.
Trip List
able to receive their top choice.
Costa Rica 2
Please be aware only a small percentage of students will be
10th-12th
June 21-July 4
Student Application
For Students: Please complete the following questions: Your answers play a crucial role in team
selection, please be as thorough as possible.
SPIRITUAL WALK
..........................................................................................................................................................................................................
1. Explain how you know that you are a Christian and tell the story of how you came to faith in God.
2. When given the opportunity, how would you encourage others to know Him?
3. What is something that God has taught you recently?
PERSONAL GROWTH
..........................................................................................................................................................................................................
1. What do you think are your strengths and weaknesses and/or spiritual gifts (if known)?
2. How do you hope to be changed as a result of going on a trip?
Student Application
3. How would you like to be challenged to grow?
4. How do you respond to adversity/conflict?
5. If you have been on a mission trip before, what were your positive and negative experiences? What did you learn
about yourself? What could you do better?
SERVICE
.............................................................................................................................
........................................................
1. In what areas have you served at Bent Tree, in the community, or at your school over the last six months?
2. What other mission trips have you been on? What are your expectations for this summer?
MISCELLANEOUS
............................................................................................
1. Who did you give your personal reference to?
Reference
Phone Number
.........................................................................................
Reference
Email Address
2. Can you commit to attend the scheduled training meetings for the trips you are applying for?
(Please see the Important Dates Sheet.) If you are unable to attend all meetings, this may effect
participation.
Yes
Not all of them Explain:
Mission Trip Agreement
Student
Parent
Expectations for Participation (Please initial each expectation):
Attend all training sessions with the team prior to the trip.
Attend team building times and team retreat, if applicable.
Discuss in advance with the team leader if a scheduling conflict arises. Approval must be obtained to miss a meeting.
Maintain Christ-like character and behavior.
Handle any and all medical needs/immunizations prior to the trip.
Raise prayer and/or financial support.
Pay acceptance fee as noted in trip booklet at first team/parent meeting February 15.
Commit to: Praying before, during, and after the trip, submitting to the authority of the leaders, valuing unity of the team, and having a
flexible, servant attitude.
Payment Schedule
If I am able to participate in the Mission Journey I commit to raise support and submit:
Percentage or Amount
Deadline
See trip book for acceptance fee amount
With approved application and/or by first team meeting
50%
Within 2 months of departure
75%
Within 1 month of departure
85%
Within 2 weeks of departure
Balance Remaining
Prior to departure
**Failure to adhere to these deadlines may result in removal from trip.
Student
Parent
Cancellation Procedure:
Applicant must submit a letter in writing to the Student Missions Coordinator stating the reason they no longer wish to participate in the trip.
Applicant must send a letter to supporters informing them of his/her decision to not go on the trip and advising them that support will go
towards others on the trip.
For trips in June, cancellation must occur before March 1 for no additional costs to be incurred. If airline ticket has been purchased, student
will be responsible for that amount. For trips in July, cancellation must occur before April 1 for no additional costs to be incurred. If
cancellation occurs after these dates, the applicant must pay the difference between the cost of the trip and amount of support raised. Plane
tickets will be retained by Bent Tree for future use. If at least 50% of the fund raising is not in by the time to buy plane tickets, payment for
that will be requested.
Student
Parent
Trip Guidelines:
For medical expenses incurred during a trip, receipts will be obtained and given to the parent(s) upon return. Reimbursement to Bent
Tree needs to take place as quickly as possible. Filing claims with your insurance company is at your discretion and will not be done by Bent
Tree and/or its staff.
If a student becomes ill and needs to return home, the expense will be the
responsibility. If medically necessary, an adult will
accompany the student. If not, the student will fly home unaccompanied.
If a
behavior is deemed unacceptable by Bent Tree staff or its trip leaders, the student will be removed from the team or sent home
at the
s expense.
name posted on the Bent Tree Bible Fellowship website from January 23-25 for team placement decisions. If you do not
I agree to have my
give permission to have their name posted, sign here.
By signing this agreement, I am indicating that I would like to participate in a Bent Tree Bible Fellowship student mission trip, and I agree to all
items contained in this agreement.
Name
Signature
Date
By signing, I/we understand and agree to the items contained in this agreement and agree to support our student fully in the mission trip process.
Note: BOTH parents with legal guardianship rights must sign.
Parent or Guardian
Signature
Date
Parent or Guardian
Signature
Date
Mission Trip Agreement-Parent Copy
Student
Parent
Expectations for Participation (Please initial each expectation):
Attend all training sessions with the team prior to the trip.
Attend team building times and team retreat, if applicable.
Discuss in advance with the team leader if a scheduling conflict arises. Approval must be obtained to miss a meeting.
Maintain Christ-like character and behavior.
Handle any and all medical needs/immunizations prior to the trip.
Raise prayer and/or financial support.
Pay acceptance fee as noted in trip booklet at first team/parent meeting February 15.
Commit to: Praying before, during, and after the trip, submitting to the authority of the leaders, valuing unity of the team, and having a
Payment Schedule
If I am able to participate in the Mission Journey I commit to raise support and submit:
Percentage or Amount
Deadline
See trip book for acceptance fee amount
With approved application and/or by first team meeting
50%
Within 2 months of departure
75%
Within 1 month of departure
85%
Within 2 weeks of departure
Balance Remaining
Prior to departure
**Failure to adhere to these deadlines may result in removal from trip.
Student
Parent
Cancellation Procedure:
Applicant must submit a letter in writing to the Student Missions Coordinator stating the reason they no longer wish to participate in the trip.
Applicant must send a letter to supporters informing them of his/her decision to not go on the trip and advising them that support will go
towards others on the trip.
For trips in June, cancellation must occur before March 1 for no additional costs to be incurred. If airline ticket has been purchased, student
will be responsible for that amount. For trips in July, cancellation must occur before April 1 for no additional costs to be incurred. If
cancellation occurs after these dates, the applicant must pay the differencen between the cost of the trip and amount of support raised. Plane
tickets will be retained by Bent Tree for future use. If at least 50% of the fundraising is not in by the time to buy plane tickets, payment for
that will be requested.
Student
Parent
Trip Guidelines:
For medical expenses incurred during a trip, receipts will be obtained and given to the parent(s) upon return. Reimbursement to Bent
Tree needs to take place as quickly as possible. Filing claims with your insurance company is at your discretion and will not be done by Bent
Tree and/or its staff.
If a student becomes ill and needs to return home, the expense will be the paren responsibility. If medically necessary, an adult will
accompany the student. If not, the student will fly home unaccompanied.
If a
behavior is deemed unacceptable by Bent Tree staff or its trip leaders, the student will be removed
from the team or sent home at the
expense.
name posted on the Bent Tree Bible Fellowship website from January 23-25 for team placement decisions. If you do not
I agree to have my
give permission to have their name posted, sign here.
By signing this agreement, I am indicating that I would like to participate in a Bent Tree Bible Fellowship student mission trip, and I agree to all
items contained in this agreement.
Name
Signature
Date
By signing, I/we understand and agree to the items contained in this agreement and agree to support our student fully in the mission trip process.
Note: BOTH parents with legal guardianship rights must sign.
Parent or Guardian
Signature
Date
Parent or Guardian
Signature
Date
Parent Reference/Recommendation Form
Student Name:
Your student is currently being evaluated for participation on a short-term mission trip. We would
appreciate your candid response to the following questions to assist us in the evaluation process.
Parent(s) Name:
1. Do you fully support your
desire to go on a mission trip?
2. What do you feel are your
greatest strengths?
3. In your opinion, in what areas does your student need to grow?
4. Do you see your student as a positive influence within their friend groups? Explain.
5. When in conflict, what is the best way to approach your student? How do they respond?
6. What are you hoping to see happen in your
life?
Y
N
Authorization to Permit Use of Over-the-Counter Medications
Name:
Date of Birth:
Current Age:
Current Weight:
I permit my student
to take/use the following over-
the-counter medications (or their generic equal) according to manufacturer"s directions, should my
student report a minor complaint to one of the trip leaders. (i.e., headache, muscle pain, stomach
ache, small cuts, blisters, sunburn, etc.) All medications are to be dispensed by an adult trip leader.
Advil
Tylenol
Aspirin
Head/Cold Congestion relief
Anti-Diarrheal
Dramamine
Pepcid/Tums
Benadryl/Antihistamine
Aloe Vera
Sunscreen
Cough Drops
Parent Signature
Date Signed
THIS AUTHORIZATION EXPIRES DECEMBER 31, 2015
Personal Reference/Recommendation Form
Applicant Name:
Grade:
The above named applicant is currently being evaluated for participation on short term mission trip. We would appreciate your candid response to the
following questions to assist us in the evaluation process. Your responses will be kept confidential.
Evaluator Name:
Phone:
Email:
1. How long have you known the applicant? What is your relationship to him/her?
2. In what ways do you feel the applicant is an influence on others?
3. What are the first words that come to your mind to describe this student?
One of the top few
encountered
Excellent
(top 10%)
Very Good (well
above average)
Good
(above average)
Average
Please indicate your
knowledge of the
abilities as
compared with those
his/her age.
Below Average
4. In your opinion, in what areas does the applicant need to grow?
Motivation
Initiative
Capacity for growth
Concern for others
Self-confidence
Integrity
Spiritual maturity
Respected by peers
Responsibility
Ability to Communicate
*Please return to Lauren Fuston, Bent Tree, 4141 International Pkwy, Carrollton, TX 75007 by 1/4/2015.
To be completed by a Bent Tree Student Ministries leader or other Bent
Tree attender.
Student Missions Important Dates
1/23/15
1/24/15
Teams Announced on Bent Tree Website
Team Introduction Meeting
5:00pm
2:00 pm - 3:00 pm
1/24 /15
Jeff Allen Comedy Night
3:00 pm - 9:00 pm
2/15/15
Parent Meeting/Meeting #1
1:00 pm - 3:00 pm(MS)
3:00 pm - 5:00 pm(HS)
3/1/15
Meeting #2
1:00 pm - 3:00 pm(MS)
3:00 pm - 5:00 pm(HS)
3/29/15
Meeting #3
1:00 pm - 3:00 pm(MS)
3:00 pm - 5:00 pm(HS)
5/3/15
Meeting #4
1:00 pm - 3:00 pm(MS)
3:00 pm - 5:00 pm(HS)
5/31/15
Parent Meeting/ Meeting #5
1:00 pm - 3:00 pm(MS)
3:00 pm - 5:00 pm(HS)
6/3/1 5
Missions Festivus
7:00 pm - 8:30 pm
3:00 pm - 5:00 pm
The following teams will have service weekends:
4/10 - 4/12
4/17 - 4/19
4/24 - 4/26
Los Angeles 2, Honduras, Costa Rica 1
Los Angeles 1 (at Father/Teen Retreat)
Costa Rica 2, Navajo, Joni & Friends

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