Haiti Mission Trip

Haiti Mission Trip Form

March 22-29, 2019
STUDENT NAME*

First NameLast Name
COST

Deposit: $300.00 (This is to ensure commitment and to secure specific trip numbers with RMI.)

Total trip cost: Around $2500.00 (The exact cost will vary depending on airfare, food costs, and the specific projects we will be participating in.)
WHAT TO PACK
- Bible
- Notebook/pen
- Toiletries/personal hygiene
- Towel
- Pillow
- Water bottle
- Appropriate clothing (more below)
- A flexible attitude!
CLOTHING / DRESS CODE

“As a reminder, the general rule for most events and activities is that men should always wear pants and ladies should always wear a skirt (no shorter then knee length) and top that covers their shoulders. Ties for men in church services are suggested for team members, but only required if you are preaching. During moments of relaxation at Zanglais Ministry Center, while in Cayes with the missionaries, while resting on the front porch at your Sister church, or doing physical work projects, shorts are acceptable. Note, that during hard physical labor, it’s your decision, but we suggest pants for safety reasons.” – RMI Team
WHAT NOT TO PACK
- Large electronic devices
- Weapons
- Lighters/matches
- Pets
ITEMS TO CONSIDER
- Cell phones
- Instruments
- Cameras
- Games
- Gifts for our sister church
- Additional spending money
OTHER CONSIDERATIONS

(We'll discuss in the first trip meeting.)
- Having a passport that is good through October 2019
- Getting your immunizations
- Collecting an offering for the project portion of the trip
- Flights to Port au Prince
WHY DO YOU WANT TO GO ON THIS TRIP?*
HOW HAS GOD GOT A HOLD OF YOUR LIFE (TESTIMONY)?*

Student's name*

First NameLast Name
Date of birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Parent/Guardian #1*

First NameLast Name
Parent/Guardian's phone*

Area CodePhone Number
Relationship to student*
Parent/Guardian #2*

First NameLast Name
Parent/Guardian's phone*

Area CodePhone Number
Relationship to student*
Name of EMERGENCY CONTACT PERSON if above references are not available*

First NameLast Name
Emergency contact's phone*

Area CodePhone Number
Relationship to student*

"I am the parent or legal guardian of the above named minor child and hereby consent to the minor child’s full participation of the above referenced event, including but not limited to, any and all activities/transportation/lodging accommodations for this event as it pertains to the Walloon Lake Community Church’s (WLCC) involvement of said event."
Initials

Clear
"Further, I give permission for the above mentioned minor child to ride with a licensed driver that has been approved by WLCC and/or its staff, except for the following person(s): _________________________________, or [NONE]."
Unapproved persons (or say NONE)*
Initials

Clear
"I further give consent that my minor child may be left at a public place such as a school, restaurant, grocery store or where they request. This permission is only revoked when submitted by me in writing and actually received by WLCC."
Initials

Clear
"I understand that, in the event that medical treatment is required, every effort will be made to contact me. However, if I not the above-referenced emergency contact person(s) cannot be reached, I give my permission to those in charge (youth pastor, leaders, or chaperones) to secure the services of a licensed physician to provide the care necessary, including anesthesia, for the minor’s well-being. I agree to assume the cost of any care/services or treatment rendered. I understand this is a legal document and agree to release and hold harmless WLCC, WLCC employees, board members, volunteers, and their members or their insurers or representatives from any liability whatsoever for the above-mentioned event, including but not limited to any transportation to and from the event. I consent to the minor’s participation in the activity. I have the authority to sign for the minor, and bind the heirs, representatives, and assigns of the minor.”
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date

My medical insurance company*
My policy number*
Physician's name*

First NameLast Name
Physician's phone number*

Area CodePhone Number
Please list any allergies, medications taken, medical problems, or other pertinent information.
Should be Empty:

Haiti Mission Trip Form