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Outreach Application Form


SHORT TERM TRIP APPLICATION

Participant Information

Is this your passport name?

Sex:

T-shirt size:

Emergency Medical Information

 

The information I have provided is true and complete to the best of my knowledge and I authorize Blessman International to verify the authenticity of my statements with the appropriate authorities. I understand that this mission trip could be highly physically and spiritually demanding, and I am physically capable of performing the actions necessary to participate. In the event that I am accepted to be a participant in this mission trip, I commit to fulfilling the requirements and submit myself under the authority of the trip leaders. I understand that Blessman International has taken efforts to ensure each team members’ safety on the mission field but also understand that unforeseen events could endanger team members beyond the control of Blessman International. I will not hold Blessman International liable for any accidents, injuries, or illnesses that occur on or due to a mission trip. I understand that at any time I feel uncomfortable with an activity in which the team is participating that I have the opportunity to decline my involvement. I authorize the trip leaders to seek emergency medical assistance for me as deemed necessary in the event of an emergency.


Background Check Authorization

 

The information contained in this application is correct to the best of my knowledge. I hereby authorize Blessman International, Inc. and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/ investigative consumer report may include, but is not limited to the following areas: verification of social security number; credit reports, current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.

I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Blessman International, Inc. or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.

**Blessman International, Inc. and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicants personal information, including, but not limited to, addresses, social security numbers, and dates of birth.

Notice to California, Minnesota and Oklahoma Residents:

Please check the box below if you wish to receive a copy of a consumer report that is requested.

I wish to receive a copy of any Background Check Report on me that is requested.


ASSUMPTION OF RISK AND INSURANCE ELECTION

Blessman International, Inc

Directions: Every trip participant must fill out this form and return it to Blessman International, Inc. before their departure. The cost of this insurance is included in the fixed cost of your trip. Please note that this form will not be considered complete without the signatures of two witnesses as specified on the back. More detailed information about the insurance plan is available at www.volunteercard.com. Please call us if you have questions.

PART1-Assumption of Risk

I, (name of volunteer), in consideration of my acceptance as a short-term volunteer with Blessman International, Inc. represent and agree that:

  1. I am a volunteer worker and acknowledge that I am not an employee of Blessman International, Inc.
  2. I am aware of the hazards and risks to my person and property associated with serving in a missions capacity, such hazards and risks including, but not being limited to, death or injury by accident, disease, war, terrorist’s acts, weather conditions, inadequate medical services and supplies, criminal activity, and random acts of violence. I accept my assignment with full awareness of these risks, and, subject to the insurance coverages described below, I voluntarily assume all risks of death, injury, illness, and damage to myself or any member of my family associated with such risks, and any damage to my personal property. I further recognize that such risks have always been associated with missionary service (2 Corinthians 11:23-28).
  3. I attest and certify that I have no medical conditions that would prevent me from performing my duties.
  4. Subject to insurance coverages described below, I waive and release any and all claims for damages which I, or my heirs or successors, may have against Blessman International, Inc. or the local church sponsoring the trip, or any agent or employee of any of such organizations, arising from my death, injury, or illness, or any property damage or loss occurring during the term of my assignment or as a result of my assignment.
  5. In the event that I have minor children who will accompany me on my assignment, I, acting both on my own behalf and in their behalf as their parent and legal guardian, and subject to the insurance coverages described below, do hereby assume all risks of death, illness, or injury that they may suffer as a result of said assignment, from those causes described above.
  6. I understand and accept the following policy of Blessman International, Inc. regarding ransom payments:
    Blessman International, Inc. has determined that it will not pay ransom nor yield to the demands of anyone who takes one of our missionary family or staff hostage. Blessman International, Inc. pledges itself to every effort in prayer and all other appropriate means to obtain the release of one taken hostage should it ever occur. This policy was made after sufficient study of the policies of other evangelical missionary societies and after considering the advice of the United States’ State Department.
  7. I expressly waive any defense to the enforcement of any provisions of this commitment arising from a claim of lack of consideration and warrant that this commitment constitutes a legal, valid, and binding obligation upon me enforceable against me in accordance with its terms.
  8. I expressly agree that this assumption of risk and indemnity agreement is intended to be as broad and inclusive as permitted by law. I further state that I HAVE CAREFULLY READ THE FOREGOING ASSUMPTION OF RISK AND UNDERSTAND ITS CONTENTS, AND I VOLUNTARILY SIGN THIS RELEASE AS MY OWN FREE ACT.

PART 2-INSURANCE ELECTION

I am aware of the hazards and risks to my person associated with serving in a missions capacity, as described above. I further understand that both Blessman International, Inc. currently requires the insurance coverage summarized below, that these coverages are subject to change, and that I am responsible for obtaining any additional insurance coverages that I consider necessary:

$25,000 Accident Medical Expense

$25,000 Sickness Medical Expense

$300,000 medical evacuation maximum

$25,000 repatriation of remains maximum

Please acknowledge by checking the box below:

I HAVE READ AND UNDERSTAND THIS AGREEMENT, AND I ACCEPT AND AGREE TO ALL OF ITS TERMS AND CONDITIONS. I ENTER INTO THIS AGREEMENT VOLUNTARILY, WITH FULL KNOWLEDGE OF ITS EFFECT.

SIGNATURES

*Please return this completed form with your trip application:

Blessman International, Inc
2557 106th St.
Urbandale, IA 50322

 


Team Covenant

As a member of a Blessman International outreach, I agree to:

  • Keep in mind at all times that I am an ambassador of Blessman International, my church, the Christian faith and most importantly, Jesus Christ. I will seek to model Jesus in my behavior and attitude at all times.
  • Be in prayer for my teammates, team leader, supporting organizations, hosts, and all the people God puts in my path while on this journey.
  • Be a guest, respecting the culture I have entered and being aware that my hosts’ views on politics, religion, lifestyle, time, and productivity may be different from my own. To refrain from such comments as “at home we do it this way.” I realize that our team is here for just a short while, but the local churches are here for the long term. So, I will respect their knowledge, insights and instructions.
  • Learn from as well as share with my hosts and teammates.       I will seek out teaching moments and share with my hosts and teammates. I will also humbly and graciously receive gifts, recognizing that attitudes about gifts vary by culture.
  • Dress modestly, taking into consideration my host culture’s dress expectations, as well as what is appropriate for the work I am doing.
  • Pack light and live simply, bringing only luggage and possessions that are appropriate for the service needs of the mission and the country’s culture and assuming risk for anything I bring with me.
  • Develop and maintain a servant’s attitude toward hosts, team leader(s), and teammates. I will demonstrate that I am there to serve others and share Christ by maintaining flexibility, respect, patience, and a positive attitude. Absolutely NOTHING can happen that can make me complain. Instead of whining, I will be creative and supportive.
  • I will handle any conflict in a Christian manner. I will talk directly to those I have a problem with before I gossip to anyone else about it. Then, if necessary, I will get a leader involved. I also commit to pray through these situations.
  • Remember to not be exclusive in my relationships and make every effort to interact with all team members and hosts.
  • Abstain from the use of tobacco and illegal drugs for the duration of the trip. Under no circumstances will a minor be allowed to consume alcoholic beverages.
  • Attend and participate actively in mission meetings and events throughout the year, so as to best prepare for the mission trip.

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Blessman International https://blessmaninternational.org
Signature Certificate
Document name: Outreach Application Form
Unique Document ID: 7b721b2092f5be53e5efcdbff6bafcd0389eef9d
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December 6, 2017 7:44 pm GMTOutreach Application Form Uploaded by webdev BlessmanInternational - [email protected] IP 175.158.217.173