Summer 2019 ACF East Region Missions Application
Please completely fill out this online application form and mail two recent passport photographs and a check for the $100 non-refundable application fee to ACF Missions, Inc. 6706 Annapolis Road, Hyattsville MD 20784 to reach us latest by March 30, 2019

Mission Trip Dates

Benin Republic- Thursday July 18 to Friday July 26, 2019
Uganda- Thursday, July 25 to Saturday, August 10, 2019

First Name: [Exactly as it appears on your passport] *
Your answer
Last Name: [Exactly as it appears on your passport] *
Your answer
Home Phone *
Your answer
Mobile Phone *
Your answer
Preferred Email Address *
Your answer
Passport Number *
Your answer
Date of Birth *
Your answer
Issue Date *
Your answer
Nationality *
Your answer
Expiration Date *
Your answer
Residential Address *
Street
Your answer
*
City
Your answer
*
State
Your answer
*
Zip code
Your answer
Gender *
If married, name of spouse *
Your answer
Names and DOB of Children (if any):
Your answer
Emergency Contact *
Name
Your answer
*
Relationship to you
Your answer
*
Address
Your answer
*
Phone Number
Your answer
*
Mobile Phone Number
Your answer
Alternate Emergency Contact *
Name
Your answer
*
Relationship to you
Your answer
*
Address
Your answer
*
Home phone number
Your answer
*
Mobile phone number
Your answer
Do you have any medical concerns that we should be aware of? If yes please explain. *
Your answer
Do you have any allergies we should be aware of? If yes please explain. *
Your answer
Do you have medical Insurance? *
Do you have travel insurance? *
Name of health insurance company *
Your answer
Health insurance phone number *
Your answer
Name of Primary Physician *
Your answer
Primary physician's phone number *
Your answer
Medical Release: In the case of an emergency, I hereby authorize ACF Missions, Inc. to obtain and provide such medical advice and services as deemed necessary by the Team Leader. I agree to the performance of such treatment, including anesthesia and surgery, as determined by the attending physician or health care professional. I accept responsibility for all medical costs that may exceed the coverage provided by my health care plan. *
Signature
Your answer
Have you ever been on a short-term mission trip before? *
If yes, please explain what, where, when and with what organization.
Your answer
If you have been on a previous mission trip, what was your most significant contribution? *
Your answer
What are your personal strengths? *
Your answer
What church are you affiliated with? *
Your answer
What ministries are you currently involved in at your church? *
Your answer
Do you belong to a local chapter of African Christian Fellowship (ACF)? *
What is your involvement in your local ACF Chapter? *
Your answer
Please indicate any ministry gifts, talents, interests, skills, or specific experiences that you feel may be helpful to the team during this mission trip. *
Your answer
What is your primary inspiration for applying for this year’s mission trip? *
Your answer
Please state three particular activities you are most interested in participating in: *
Your answer
What countries would you prefer to be assigned to? *
[Please note that we will try to accommodate your country and activity preferences as far as possible but the final decision will be based on what’s best for the team as a whole.]
How well do you deal with uncertainty and change?
[5 being very comfortable with change]
How would you rate yourself in flexibility and adaptability?
[5 being very flexible]
Are you willing to forego personal preferences to honor your team members and those you will be ministering to? *
Please explain briefly what you expect to see the Lord do in and through you during this mission trip? *
Your answer
How do you plan to apply the experience and lessons from this mission trip? *
Your answer
Please provide two references that we can contact to learn more about you: *
Name:
Your answer
*
Address:
Your answer
*
Name:
Your answer
*
Address:
Your answer
Release of Liability and Specific Limitations: I understand that there are certain risks inherent in overseas travel and my participation in this short- term mission trip to Africa, including but not limited to weather conditions, illness, accident or injury; and the potential lack of accessible, desirable or effective medical care. Team members, leaders and other volunteers serve at their own risk. I hereby release ACF Missions, Inc., its leadership and volunteers from any and all liabilities arising out of any injury, damage or loss which may be sustained by me during the course of my involvement in the mission trip including preparation thereof. I am aware that ACF Missions, Inc. will do whatever is within its organizational limit to ensure the safety of all team members. The mission trip experience could entail intense physical activities including continuous walking that require good physical condition. I understand that activities during the mission trip are often done in groups, and that all team members are expected to participate fully as directed by the Team Leader. As a Christian organization, ACF Missions expects team members to honor the Lord by a Christian lifestyle that is consistent with the Bible. As we seek to serve the Lord by serving those He has sent us to, we endeavor to model Christ before them. Therefore all team members are required to avoid any inappropriate relationship with persons of the opposite gender or any appearance of this. Team members are expected to adhere to all instructions given by the Team Leader and follow guidance in the interest of team cohesion. Continuous disruptive behaviors, which affect the experience or compromise the safety of other team members, may result in such team member being advised to return home at their own expense. ACF Missions, Inc. or its volunteers and leadership will not be responsible for the lost or damage to any personal property of team members. Any valuable items should be left at home. I understand that travel dates, schedules and country of ministry are subject to change. In the event that a trip is cancelled, for any reason, ACF Missions, Inc will assign team members to another trip. Every team member is expected to raise a total of $3,000.00 for the missions’ trip, to cover the cost of airfares and execution of the missions work (accommodation, feeding etc) in the missions’ field. If an individual is unable to participate in the trip, funds raised, less incurred expenses and administrative fees, will be credited to the next trip. If the individual is not able to go on the next mission trip, ACF Missions, Inc will not be able to keep the money beyond one year, and will use the money to support its missions work. I agree to attend the team meetings, training sessions, debriefing, and to participate in other post-trip informational meetings. I agree I will do my best to work towards achieving the goals of the mission trip. By signing below, I confirm that information I have provided herein is accurate and true to the best of my knowledge and that I agree with all the limitations stated above. *
Applicant's Signature
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service