Step 1 of 4 - Contact Information
Date of Birth
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District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Emergency Contact Name
Relationship to Team Member
Emergency Contact Phone
Emergency Contact Email
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Passport Expiration Date
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Code of Conduct
Code of Conduct
I agree to the Code of Conduct.
“Let us, therefore, make every effort to do what leads to peace and to mutual edification.” Romans 14:19 NIV (Other Scriptures: Titus 2:7-8, Romans 14:21, Ephesians 4:1-3, 1 Thessalonians 2:10-12, Romans 12:1-2, Titus 2:11-14, John 13:12-17, 1 Corinthians 11:1)
As a MAPS team member,
I realize the important role I serve as an example to those in the United States and abroad. I understand that I represent not only my local church, but also Assemblies of God World Missions, and most importantly, Jesus Christ.
In respect to this assignment, I will refrain from anything (e.g., alcohol, tobacco, unwholesome speech) that may distract from my Christian testimony, cause division, or demonstrate disrespect to the national church, missionary personnel, my team, or the Assemblies of God.
I promise to forgo my personal convictions on these subjects in order to maintain unity and to avoid controversy in the body of Christ.
I affirm that I do not have any criminal convictions or allegations related to sexual misconduct with an adult or minor, nor do I know of any reason I should not be allowed to work with adults or minors as a short-term missions volunteer.
Assumption of Risk, Release, and Indemnity Agreement
Assumption of Risk, Release, and Indemnity Agreement
I agree to the Risk, Release, and Indemnity Agreement.
It is impossible to predict, fully prepare you for, or furnish you with all aspects of what you may face. We have therefore prepared some basic assumptions which we both must make. Please prayerfully consider the following assumption statements before checking that you agree. Your application can not be processed without the proper compliance.
Possible activities include but are not limited to:
Evangelism - The presentation of the Christian Gospel by public preaching or personal witness through various methods, including but not limited to outdoor or indoor crusades, meetings, presentations, church services, door to door visits.
Construction - The building or repair of a structure related to the mission in the host country which can include work with building supplies, heavy machinery, electricity, lifting and carrying, climbing and work in elevated surfaces, or any other construction related activity.
Humanitarian - Activities which promote human welfare, including but not limited to providing aid in potentially treacherous conditions, regarding cleanliness and safety.
Education - Training or instruction through formal or informal settings in small or large group settings.
Healthcare - Participation in health or medically related initiatives, including, but not limited to dental, vision, immunizations, health assessments, distribution of vitamins and medications.
Transportation - May include any of the following in a public or privately owned manner: International or domestic air travel, automobile, train, motorcycle, boats, animal, bus streetcar, manually operated street vehicle.
In consideration of my acceptance as a volunteer on this missions trip, in cooperation with The General Council of the Assemblies of God, and other considerations, the sufficiency of which is acknowledged, as the named, I represent and agree that:
I, for myself, and on behalf of my spouse, children, parents, guardians, heirs, and next of kin, in addition to any legal and personal representatives, executors, administrators, successors and assigns, hereby agree to and make the following contractual representations pursuant to this Agreement:
I hereby represent the following: (1) I am in good health and in proper physical condition to participate in any of the activities described above (“Activity”); and (2) I am not under the influence of any prescription drugs which would in any way impair my ability to safely participate in the Activity. I agree that it is my sole responsibility to determine whether I am sufficiently fit and healthy enough to participate in the Activity.
I understand and acknowledge the physical rigors associated with the Activity and realize that it involves prolonged walking in various terrains. I understand that participation involves risks and dangers which include, without limitation, the potential for serious bodily injury, permanent disability, paralysis and death; accidents in the use of firearms,; inaccessibility of medical care; dangers arising from adverse weather conditions; dangerous animals; inadequate safety measures; participants of varying skill levels; situations beyond the immediate control of the travel leader; and other undefined harm or damage which may not be readily foreseeable, and other presently unknown risks and dangers (“Risks”). I understand that these Risks may be caused in whole or in part by my own actions or inactions, the actions or inactions of other participated in the Activity, and I hereby expressly assume all such Risks and responsibility for any damages, liabilities, losses or expenses which I incur as a result of my participation in the Activity.
I also accept sole responsibility for my own conduct and actions while participating in the Activity, and the condition and adequacy of the equipment I will use.
Risks of international travel.
I am aware of the hazards and risks to my person and property associated with serving in a missions capacity, such hazards and risks including but not being limited to injury; increased stress; accident; disease; inadequate medical services and supplies; death; criminal acts including terrorism; natural disasters; weather conditions; government action; risks of traveling to or from international destinations; and foreign political, legal, medical, social, and economic conditions. The country or countries to which I will travel may have health and safety standards that differ from those enjoyed in the United States, and I recognize that I may be subjected to potential risks, illnesses, injuries, and even death. I have made my own investigation of these risks, understand these risks, and assume them knowingly and willingly. I further recognize that such risks have always been associated with missionary service as in 2 Corinthians 11:23-28.
I also acknowledge that in working, living, and traveling in cities abroad, I may experience problems associated with urban living, including increased crime, pollution, high population density, standards of living, and health standards that are different from those to which I am accustomed in the United States. I acknowledge that it is my responsibility to take every precaution to safeguard my health and to protect my personal belongings from damage or theft. I acknowledge that The General Council of the Assemblies of God recommends that I never travel alone, particularly at night. Being alone, especially at night, may present additional danger to my safety and well being.
I have read and understood all information on the U.S. Department of State website
about the country or countries to which I am traveling, including, without limitation, the U.S. Department of State Consular Information and any applicable travel warnings. I also have reviewed the U.S. Centers for Disease Control health advisory information relating to travel abroad
, and any additional information available from the World Health Organization website
I understand and agree that if during my participation in the Activity, the travel leader learns that I am experiencing serious health problems, have suffered an injury, or am otherwise in a situation that raises significant health and safety concerns, then the travel leader may contact the person whose name I have provided as my emergency contact. I understand that the travel leader ordinarily will not initiate such contact without first having a discussion with me.
General release and assumption of risk.
Knowing the risks described above, I agree, on behalf of my family, heirs, and personal representatives, to assume all the risks and responsibilities surrounding my participation in the above-described activities, both known and unknown. To the maximum extent allowed by law, I release, hold harmless, and agree to indemnify The General Council of the Assemblies of God, and its affiliated ministries, and any Assemblies of God church and/or district council, and any Assemblies of God school, college or university, and their officers, directors, employees, volunteers, and agents, from and against any present or future claims, losses, liabilities, costs and expenses for injury to person or property, or for any other damage, which I may suffer, or for which I may be liable to any other person, related to my participating in said activities including periods in transit to or from my destinations, resulting from any cause, including but not limited to negligence on my part or on the part of any of the released parties; provided that this release of liability shall not apply to gross negligence or willful or wanton misconduct.
In the event that I have minor children who will accompany me on my assignment, I take full responsibility for their supervision and conduct at all times, and I, acting both on my own behalf and on the behalf as their parent and legal guardian, do hereby assume all risks of death, illness, or injury that they may suffer as a result of said assignment, from those causes described above.
I understand and accept the following policy regarding ransom payments:
The World Missions Board has determined that The General Council of the Assemblies of God will not pay ransom or yield to the demands of anyone who takes on of our missionary family or staff hostage. The General Council of the Assemblies of God pledges itself to every effort in prayer and will take all reasonable steps to secure the release of any member held hostage and/or detained. The General Council strongly opposes the payment of any extorted commodities or service and will not pay expenses incurred by captors. The General Council will not permanently concede land or remove missionaries from ministry locations as a part of any negotiated settlement with hostage takers. The General Council believes that this approach helps reduce the risk of General Council personnel being targeted for kidnapping and was made after sufficient study of policies of other evangelical missionary agencies and after considering the advice of the U.S. Department of State.
I expressly waive any defense to the enforcement of any provision of this commitment arising from a claim of lack of consideration and warrant that this commitment constitutes a legal, valid, and binding obligation upon me enforceable against me in accordance with its terms.
I expressly agree that this Assumption of Risk, Release, and Indemnity Agreement is intended to be as broad and inclusive as permitted by law. I further state that I have carefully read this agreement and understand its contents, and I voluntarily sign this agreement as my own free act.
I certify that I am aged 18 or older. I understand and agree that no oral or written representations can or will alter the contents of this document. This Agreement shall be governed and construed in accordance with the laws of the State of Missouri, excluding its choice of law rules, and all claims relating to or arising out of this Agreement, including claims for injuries or wrongful death in any way related to the Activity, shall likewise be governed by the laws of the State of Missouri, excluding its choice of law rules.
Invalidation of any one or more of the provisions of the Agreement shall in no way affect any of the other provisions hereof, which shall remain in full force and effect.
I agree to the Financial Disclosure.
Due to IRS regulation, all money received is considered a donation to Builders International. Any excess funds will go toward your team's general fundraising or construction materials. In the event that you can not attend or the trip is canceled due to unforeseeable circumstances with the government, security, or weather; all donations are considered tax deductible and donations to the project; therefore, we cannot return any funds.
I agree to the Media Policy.
In today's society, one of the greatest ways to tell a story is through pictures and video. By agreeing to the media consent policy you are giving permissions to be photographed, quoted, filmed, or videotaped for non-profit use in the forms of social media, print, and website use. You also agree to receive information from Builders International via email, regular mail, and social media. Your name and information will not be sold or shared for any reason.
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Insurance & Beneficiary
I agree to the Insurance & Beneficiary Policy.
Insurance Election. - I am aware of the hazards and risks to myself associated with serving in a missions capacity. I further understand that The General Council of the Assemblies of God currently requires the insurance coverage summarized in the Mission Assure document, that the cost of the insurance is included with the trip, and that I am responsible for obtaining any additional insurance coverages that I consider necessary.
*A copy of the Mission Assure Travel Insurance Program will be emailed to you after completion.
Beneficiary Designation Name
Policy Number: ADDN10846419 Benefits payable for loss of life are payable to the first surviving classes of the covered person: spouse; child; parent; sibling; or estate, unless otherwise indicated above.
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