Participant Information

If Participant is under 18 years of age, please complete the following:

Mission Related

Skill Level Information

1. No skill (no experience/skill with this type of work before and would require detailed direction)
2. Low skill (minimal experience & would require direction)
3. Moderately skilled (done this type of work multiple times & would require minimal direction)
4. Highly skilled (done this type of work many times before, requires no direction)
5. Professional (do professional construction work)

All skill levels are invited and encouraged to participate. This is used to evaluate our team as a whole and will help us determine the appropriate kind of work that we will do. Please respond honestly. What is your skill level regarding:

Food Service

While on some of the mission trips, all team members will be expected to help regarding meals.




I understand that by submitting this form that this is only an application and does not guarantee that I will be granted permission to participate in the mission trip. I understand that the leader(s) of the trip will determine if I am able to attend.
Further, I realize that the following commitment is crucial to the effectiveness, quality, and positive experience of the mission trip. As a member of this mission team, I agree to:
1. Lift up Jesus Christ with my thoughts, words, actions, and overall service. In everything that I do, I will remember that I am a representative of Jesus Christ and that my function is to serve God lovingly during this mission trip. I will serve as best I can so that both the spiritual purpose and the task of the mission will be accomplished.
2. Stay with the team at all times during the trip except as excused by the team leader.
3. Develop and maintain a servant attitude toward the people that our team serves, as well as toward each team member.
4. Pray for our team. Pray for and support my team leader(s) and their decisions.
5. Refrain from judgment.
6. Respect other person’s religious views, including our host, those that we are serving, fellow team members, etc., realizing that other people may express their faith differently.
7. Strive for harmony among team members, hosts, and the people that we are serving. I will keep in mind and respect local conditions and customs. I will follow the teachings of Jesus Christ, paying particular attention to The Golden Rule. I will follow all local laws, societal customs and traditions, avoid local taboos, and use common sense and good judgment in all things. I will be considerate, tolerant, and patient with other customs, beliefs, and needs. I will abstain from being “preachy.”
8. Abstain from the use of alcohol, tobacco (including vaping), illegal drugs. Abstain from profanity, wearing inappropriate clothing, engaging in objectionable behavior. I will refrain from negativism, complaining, and gossip.
9. Maintain a cheerful, positive, flexible, cooperative, and patient attitude. I agree to cooperate with the team leader(s), and my fellow teammates, concerning our life together, including, but not limited to daily assignments, food, lodging, and transportation.
10. Keep the main thing the main thing: to serve Jesus Christ from the time we depart to the time that we return home.

Emergency Medical Information

Your medical information will be kept confidential. Only the team leader(s) will review your medical information. The team leader(s) will review your information prior to the mission trip only for the purpose of being informed regarding any health concerns you may have so they may recognize a health emergency and respond appropriately. During the mission trip, the team leader(s) will keep your information in a sealed envelope and will only be opened in case of an emergency. When the mission trip is completed, your medical information will be destroyed via a paper shredder.

Health Insurance

Medical Information

Primary Care Provider

Emergency Contact

West Lawn United Methodist Church Release

Authorization of Consent to Treatment

I (name), do hereby authorize West Lawn United Methodist Church mission team leader(s), as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any physician or surgeon licensed under the provision of the Medical Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or at a hospital.
It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required, but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment, or hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable.
This authorization shall remain effective throughout the entire length of the mission trip (from time of departure at West Lawn United Methodist Church until return to West Lawn United Methodist Church).

Release of West Lawn United Methodist Church

I (name), shall indemnify, hold free and harmless, assume liability for, and defend West Lawn United Methodist Church, its agents, its pastors, employees, servants, its members, and designees from any and all costs and expenses including but not limited to, attorney’s fees, reasonable investigative and discovery costs, court costs, and all other sums which West Lawn United Methodist Church, assertion of liability, or any claim or action founded thereon, arising or alleged to have arisen out of use of real or personal property belonging to West Lawn United Methodist Church, its agents, its pastors, employees, servants, its members, and designees, or by action of omission by myself.

Image Consent

I hereby grant permission to West Lawn United Methodist Church and its designees to photograph and video me, otherwise capture my image, and make recordings of my voice. I further grant to West Lawn United Methodist Church and its designees the right to reproduce, use, exhibit, display, broadcast, and distribute these images and recordings in any media now known or later developed for promoting, publicizing, or explaining West Lawn United Methodist Church’s and its activities for any purpose it deems necessary. I acknowledge the church’s right to crop or treat the image(s) at its discretion. I also understand that once my image is posted on the Internet, the image may be downloaded by any computer used, anywhere in the world. Therefore, I agree to indemnify and hold harmless West Lawn United Methodist Church, its agents, its pastors, employees, servants, its members, and designees from any claims arising out of the use of my image(s). Photographs, video images, and voice recordings are the property of West Lawn United Methodist Church.