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Mission trip applying for: YAM New York City Urban Impact Mission Trip Dates: June 16-June 22 Last Name:_________________________ First:_______________________ Middle:_________________________ Date of Birth: _______________________ Phone: House:______________________ Work:_______________________ Cell: ____________________________ Address: ________________________________________________________________________________________ Email: _____________________________________________ Frequency you check email: ____________________ Are you a member of FLM? _____________ o Approximate date of membership: ____________ If not a member of FLM, what church do you attend? ______ _______________________________ Do you attend at least one service a week? ___________ How do you plan to pay for the trip cost and expenses while traveling?
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If you will be raising support, please include your plan:
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As a part of this team, it is expected that each team member be physically fit, willing, and able to participate by possibly walking or hiking long distances, and standing for long periods. Are there any physical limitations we should be aware of in considering your application? __________________________________________________________________________________________ __________________________________________________________________________________________
All information provided in this application is true and complete. I understand that being a team member is a privilege and I must be approved to travel on this trip. I understand that no potential team member will be considered until the Hold Harmless agreement is signed.
5. I the participant will obey the rules and regulations as stated below, which may be subject to change in order to manage the safety and wellbeing of all participants involved. FLM MISSIONS TRIP RULES & REGULATIONS 1. Be in agreement with the vision and purpose of this trip and be in full support of the effort. 2. Be willing to submit to leadership in charge. 3. Be willing to work as a team member with a spirit of love and cooperation. 4. NO strife, complaining, competition, or gossip. 5. Maintain a neat personal appearance. 6. Do not use this trip for personal business or ministry gain. 7. Any secular music found will be confiscated and not returned! 8. Consumption of drugs or alcohol of any type is not permitted. 9. Appropriate behavior w/the opposite sex (NO public (or private) displays of affection amongst any unmarried team members). 10. Failure to adhere to these rules may result in early dismissal from the trip at the expense of the individual/parent.
BY SIGNING BELOW THE PARTICIPANT (OR PARENT/GUARDIAN, IF PARTICIPANT IS A MINOR) ACKNOWLEDGES AND ACCEPTS THE ABOVE AGREEMENT To be completed by participant (or parent/ guardian, if participant is a minor)
Name (please print) ___________________________________________________________________________________ Address _____________________________________________________________________________________________ Parents/ Guardians ____________________________________________________________________________________ Home Phone _________________________ Work Phone _________________________ Other phone _________________ Name of emergency contact/ relationship: __________________________________________________________________ Home Phone _________________________ Work Phone ________________________ Other phone__________________ Is an FLM representative authorized to approve medical treatment? Yes____ No____ Date of last tetanus shot ___________ Please list any medical conditions, problems or concerns, allergies? _____________________________________________ Current medications being taken (for allergies etc) _________________________________________________________ _________________________________________________________________________________ Date: _____________ Signature of parent/guardian: ____________________________________________________ Date: __________________