Mission Trip Registration

STM - Puerto Rico 2019

STM Puerto Rico 2019 trip
8/4/2019 - 8/10/2019
$1,450.00

Additional Information

This section is to be answered by the individual attending the trip.
*Please select a trip:
*Status:
*T-Shirt Size:
*Birthday:
*Birthplace (City, State, Country):
*Citizenship:
*Do you have a current passport?:
*Name of Employer:
*Employer's Address:
*Job Title:
*Are you a member of Woodside?:
*Woodside Campus:
*Have you been baptized by immersion after salvation?:
*Have you completed Woodside's Child Protection Program?:
Please tell us who to notify in case of an emergency.
*Emergency Contact Name:
*Emergency Contact Relationship (Mom, Dad, Husband, Wife, etc.):
*Emergency Contact Address:
*Emergency Contact Cell Phone Number:
*Emergency Contact Email Address:
Skill Set/Interests
*What skills do you have? Please describe.:
*What interests you about this trip?:
*When were you saved? Please share your testimony.:
*What do you hope the Lord will do in and through you on this mission trip?:
*Family Physician Name:
*Family Physician Address:
*Family Physician Phone Number:
Please list any chronic or exisiting medical conditions (i.e. asthma, seizures, diabetes):
Please list any known allergies (food, medicinal or seasonal):
List all current medications:
Recent Shots & Vaccines:

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CODE OF CONDUCT

As a member of a Woodside Bible Church mission team, I understand I represent not only Woodside Bible Church but also the host ministry, Christians form the United States and Jesus Christ. As a member of this mission team, by signing this application, I am agreeing to the following terms:
1. Complete team building, training, and trip preparation exercises determined by team leaders.
2. Attend and arrive promptly to all team meetings and functions.
3. Conduct myself as s guest and servant in a manner that brings Glory to God.
4. Submit to and respect the team leader, field host's authority and group needs over my own.
5. If the team leader approaches me about my behavior, I will respond with humility and repentance.
6. Return home at my own expense if my behavior is a problem determined by my team leader.
7. Abstain from the use of alcohol, tobacco and illegal drugs.
8. Abstain from conduct which would be offensive to the host culture and to my Christian witness.
9. Be flexible in all circumstances, committed to upholding team unity in less than ideal conditions.
10. Refrain from gossiping, complaining and stirring up negativity.
11. Agree to not form new romantic relationships with team members or nationals while on the field.
12. Already existing relationships will limit their public physical expression and not isolate themselves.
13. Agree not to engage in immoral conduct or inappropriate physical contact with others. 
14. Contribute to the team's assigned work, willing to undertake tasks requested by the team leaders.
15. I won't be overly demanding, I will do my best not offend or embarrass the local mission host.
16. Assume full responsibility for all requirements regarding passports, visa and vaccinations.
17. Assume full financial responsibility for my trip and comply with scheduled payment of finances.
18. Refrain from giving of gifts, without first consulting and receiving approval from the team leader.
19. Dress modestly. Yoga style, tight fitting leggings are NOT allowed. No two piece bathing suits, halter tops, short shorts or Speedo's.
20. Electronic devices are permitted, if determined by the trip leader, to enhance our trips purpose. 
SHORT TERM TEAM LIABILITY RELEASE

I UNDERSTAND THAT PARTICIPATION IN THE ACTIVITIES OF Woodside Bible Church, as a missionary or volunteer worker is a privilege.  I acknowledge that such participation may expose my family and me to a number of hazards, whether physical, emotional, or economic, as a result of my participation.  I further understand that transportation or medical facilities may be primitive or inadequate in the location where I am serving.   In consideration of this privilege, I accept these hazards and risks voluntarily, and agree to release and hold harmless Woodside Bible Church, it’s officers, members, employees, agents, representative, successors and assigns from any and all claims that I may have which would arise out of my participation or service on the short term mission team, including, but not limited to, any travel related to the trip.  I specifically release and waive any claims sounding in tort or contract, all claims for personal injury or loss or damage to personal property, and any and all claims for economic or non-economic loss, however characterized.*

FOREIGN TRAVEL ACCIDENT AND SICKNESS COVERAGE

  • Name Insured(s): Woodside Bible Church
    • Policy Number: WS11001875
    • Policy Term : March 01, 2018 - March 01, 2019
    • Date Of Issue: 03/2018
  • Classification of Insured Person(s):
    • North American Employee(s)
    •  Scheduled Individual(s) or Group(s) - endorsed separately
  • Limits of Liability
  • Coverage A, B - Accidental Death and Dismemberment - 24-Hour Protection (subject to percentages per Table of Losses)
    • $200,000 Principal Sum Insured, each Insured person or five (5) times the insured person's annual salary whichever is the lower 
      •  $2,000,000 Aggregate Limit
  • Coverage C - Accidental and Sickness Medical Expense
    •   $100,000 Covered medical expense, each Insured person each Injury or Sickness 
    •   $500 Deductible per Insured person, per each Injury or Sickness
  • Coverage D - Emergency Medical Evacuation
    • $100,000 Covered Expenses, each Insured person each Serious Injury or Sickness
  • Coverage E - Emergency Family Travel
    • $10,000 Covered Expenses, each Insured person $100,000 Maximum, for all Insured person(s) any one Accident or Sickness
  • Coverage F - Repatriation of Remains
    • $25,000 Covered Expenses, each Insured person $100,000 Maximum for all Insured person(s) any one Accident or Sickness

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*I agree to the above Medical Release, Code of Conduct, Short Term Liability Release, Foreign Travel Accident & Sickness Coverage:
*In the box below, please enter the full name of the person who is accepting the agreements above. This will be considered your legal signature.
Today's Date: