Improv

High School Ministries

---------------Calvary Los Gatos--------------

Guatemala 2013 Application

ImprovLG exists to be a safe place for students to: explore the life and teachings of Jesus, connect with other students, and with Christ-centered leaders. Our prayer for all our students is to become missional and incarnational disciples of Jesus. So heres the deal, these High School Go Teams are life changing. We can experience and learn from God here in our hometowns, but wouldnt it be awesome to experience Him working in other ways in Central America? The two weeks in Guatemala be amazing, memorable, and heart-transforming; the prep time will surprise you; and the time upon our return will continue to challenge your thoughts and relationship with God. This is not a vacation, but rather something much greater. It is a lot of work. Well be working on fundraising, Bible studies, discipleship, craft preparation, Spanish practice, and some other things that will come up throughout the process. Take a step back and look at your next 7 to 8 months and think about what you want to do. It may take up some time you normally would spend with friends or doing other things. Is this team an experience you are seriously interested in? If you said yes, keep reading! Heres directions from Los Gatos to Guatemala 1.) Pray 2.) Attend Interest Meeting 3.) Talk to your parents, look at your schedule, understand the commitment 4.) Fill out and turn in this application (Initial due date: December 16th, 2012) 5.) Pray 6.) Schedule an interview with Steven Giordano 7.) Pray some more! 8.) **If you are brought on as a part of this team, there will be more directions to come**

Otra Informacion (translation: Other Information!)

Team Leader: Steven Giordano: Improv High School Staff Steve Reed: Beyond Partnership Staff/Founder Trip Dates: June 17th through June 28th Cost: $2200 (includes air fare, in-country travel, housing, meals, baggage, etc.) (NOTE: this price does not include shots/vaccinations, passport costs, personal spending money, crafts, building tools, etc.) Deposit: $350; due January 13th, 2013 (at latest! This amount cannot be raised later) -$1000 Total; due March 10th, 2013
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-$1600 Total; due April 21st, 2013 -$2200 Total; Due May 12th, 2013

Improv High School Ministries

---------------Calvary Los Gatos--------------

Guatemala 2013 Application

Name(full):_______________________________________________________________________
Date of Birth:________________________________________________________________________

Address:_____________________________City:_________________________ Zip:____________ Home Phone:____________________________Cell Phone:_________________________________ Students Email:__________________________Parents Email:______________________________

Passport: yes or no? Passport #:______________________ Date of Expiration:___________________
NOTE: Keep in mind, in this application, honesty is the key, not fluff and words that sound churchy. Have fun with it too.

Briefly share your faith story (what led to your realization that you needed a Savior, initial step, etc....) How would you describe your current relationship with God (please not just one word :) )?

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Why do you want to go to Guatemala on this Go Team?

Will you be able to commit to team meetings? Will you be able to commit to all team deadlines?

Yes Yes

or or

NO (circle one) NO (circle one)

Will you be able to commit to responding promptly to all team communications (texts, emails, facebook messages, carrier pigeons, morse code, etc.)? Yes or NO (circle one) By signing below, students, you are agreeing to being at all team meetings, meeting all team deadlines, as well as responding to team requests. Parents, by signing below, you are agreeing to be an integral part in the journey with your student. This means encouraging them, keeping them on task, and acknowledging that you are ultimately financially responsible for your student being able to make this trip. _________________________________ (Student/Staff)

________________________________ (Parent/Guardian)

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Calvary Church GO Team Application

Full Name (as on Passport):___________________________ Parents Names:_____________________________________
Please attach a recent color photo of yourself in this space. Passport size preferred.

HEALTH
Confidential information for use in medical emergencies

Insurance info

PHOTO IS q Check here if no health insurance REQUIRED

Name of health insurance company ___________________________________ Policy number ____________________________________________________ Primary doctors name and phone ______________________________________________________________________________ ______________________________________________________________________________ __________________
Calvary Church does not carry accident insurance for group activities or Go Team Trips. Should an accident or injury occur, you are responsible to cover all the medical expenses involved. The information you provide above will help us in getting immediate medical care should an accident occur. Please make sure and check with your insurance company as to whether you are insured internationally. q I give any licensed, practicing physician or hospital full authority to provide emergency medical treatment for me in the event such treatment is needed or necessary and I am not able to make such a decision. I also hereby give my permission for a licensed practicing physician to administer whatever medical treatment he/she may deem necessary for me in the event of any medical emergency affecting me.

Emergency Contacts
1. Name (not a team member) ________________________________________ Relationship ____________________________________________________ Day Phone ______________________ Evening Phone __________________ 2. Name (not a team member) ________________________________________ Relationship ____________________________________________________ Day Phone ______________________ Evening Phone __________________ Please list any medical conditions helpful for a physician to know should you require emergency medical attention during the trip: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ___________________________ Diet (explain any special dietary needs): q None ______________________________________________________________________________ ______________________________________________________________________________
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______________________________________________________________________________ ___________________________ q None Please list all medications (name and dosage) you are currently taking: __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________

Medication

List any history of major illness or surgery: q None ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ___________________________ q None Specify any allergies (including foods) or life-threatening conditions and describe reactions: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ___________________________

Allergies

Condition (please indicate any of the following that you cannot tolerate):
___ Rigorous outdoor activity ___ High altitudes ___ High humidity ___ Air travel ___ High temperatures ___ Low temperatures ___ Other: _______________________________________________________ Please explain any item(s) checked: ______________________________________________________________________________ ______________________________________________________________________________ __________________

Temperament (indicate which characteristics seem to apply to you):

___ Impulsive ___ High strung ___ Moody ___ Calm ___ Easy going ___ Introspective ___ Self-conscious ___ Shy ___ Aggressive ___ Dominant ___ Leader ___ Follower ___ Other: _______________________________________________________

ABILITIES
Present occupation ________________________________________________ Name of employer or school _________________________________________
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If you are a student, list grade most recently completed ___________________

CROSS-CULTURAL/TRAVEL EXPERIENCE
Have you ever traveled out of the United States? q Yes q No If yes, please list countries: __________________________________________ Have you previously participated in a Calvary GO Team? q Yes q No If yes, please list destination(s) and date(s): ______________________________________________________________________________ ______________________________________________________________________________ __________________

REFERENCES
1. Name_______________________________ Relationship ___________________________ How long have you known this person? _______________________________ Cell Phone ________________________ Email ________________________ 2. Name_______________________________ Relationship ___________________________ How long have you known this person? _______________________________ Cell Phone ________________________ Email ________________________

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Calvary Baptist Church of Los Gatos GO Team Release of Liability Agreement

I,_________________________________(print full name), acknowledge that I am participating on a Go Team through Calvary Baptist Church of Los Gatos (Calvary.) I will not hold or attempt to hold Calvary liable for any loss, damage or injury to person or property caused by any act or neglect of other persons on or about this trip, and I will indemnify and hold Calvary harmless from any liability for damages or claims against Calvary arising out of or in any way related to any such loss, damage or injury. I release Calvary, including its trustees, employees, and agents from my physical injury, including death or illness while on this trip or while in transport to and from there. I will assume the risk associated therewith, whether known or unknown to me at this time. This release is also intended to include all claims of my family, estate, heirs, personal representatives or assigns. I verify that I am in good health and am capable of participating in strenuous activities, and when necessary, will tailor my activities to those within the bounds of my physical health. I hereby swear that I am 18 years age or older and am legally able to sign this release. By typing my name in the signature box below, I acknowledge that I have read and agree to all information contained and that this will serve as my true signature. ____________________________________________ _________________________ Signature Date In case of emergency, please contact ______________________________________________ Phone number _______________________________________________________________ If I am under 18, my parent or guardian, by signing below, also consents to my release and he or she agrees that this release shall be binding upon him or her as my parent or guardian as to me and my estate, heirs, personal representatives and assigns. My parent or guardian also promises, by signing below to defend, indemnify and hold Calvary harmless form any claim asserted by me against Calvary, including its trustees, employees and agents, if I should repudiate this release after obtaining adulthood. ____________________________________________ _________________________ Signature of parent or guardian Date ____________________________________________ Printed Name of parent or guardian In case of emergency, please contact ______________________________________________ Phone number _______________________________________________________________

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FINAL AGREEMENT
If selected to be a member of this GO Team, you will be expected to honor each of these commitments. Please initial each one, acknowledging your agreement. By typing my initials on each line and typing my name in the signature box below, I acknowledge that I have read and agree to all information contained and that this will serve as my true signature. ______ I understand that prior to my going on the trip, I am responsible for covering any shortfall in my trip finances. Any amount due is ultimately my responsibility. I understand the total amount is due 30 days prior to the trip departure date. ______ I understand that contributions (either my own or others on my behalf) are non-refundable in the event that I do not participate in this trip (whether by my choice or that of the church). Funds will be applied toward the trip project costs. ______ I will be supportive of the leader(s) chosen for this trip and will submit to his/her/their overall leadership. ______ I will enter this trip with a spirit of flexibility, realizing that a number of our plans will inevitably change while in a cross-cultural setting. ______ I will attend all GO Team meetings, realizing participation in these meetings is non-negotiable. ______ I understand that Calvary Church has the right to discontinue my involvement in this trip at its sole discretion. ______ I will be a team player, placing the needs and objectives of the group above that of my own. ______ I agree to allow the leaders the keep me accountable in upholding the agreements I have signed. ______ In case of emergency, I hereby give my permission to any licensed physician and hospital selected by the team leader to hospitalize, secure treatment for, and to order injection, anesthesia, or surgery for myself or the below named. I understand that Calvary Church will not be held responsible in the event of accident or injury. ______ I understand that I am required to provide a 10% (of the total trip cost), non-refundable deposit, with the submission of this application. ______ I understand that the total cost of this trip does not include any immunization costs, medicine, passport costs, visa costs, souvenirs, etc.

_________________________________________________________ Signature

_____________ Date

_________________________________________________________ Signature of Legal Guardian (if under 18)

______________ Date

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Please return this GO Team Application to the church office or your trip leader.

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