2022 Christmas Mission Trip

2022 Christmas Mission Trip Application
December 3-10

Please have your passport information on hand. It would be helpful to have your flight information handy if possible. If not, no worries. If you are under 18, please have your parent or guardian ready to sign at the end of this application.
Name as it appears on your passport

First Name Middle Name Last Name
Mission Team Name *
Name of your church, school, or business going to Nicaragua
Date of your trip *

Month Day Year
Select the date your team leaves for Nicaragua
Name as it appears on your passport
First *
Middle *
Last *
Monday Item Name
This is for the first column in Monday.com
Name you go by
Do you have a valid passport? *

Yes No Applied for
Passport Number
Passport Expiration Date

Month Day Year
Expiration date should be at least three months beyond the date your trip
We recommend you IMMEDIATELY apply for a new or renewed passport. Keep in mind that depending on the options you select, it can take between 5-12 weeks for this process to be completed. Visit https://travel.state.gov/content/travel/en/passports.html
As soon as you receive your new passport, please send the following information to shawna@ccm.life:
- Your name as shown on the passport
- Passport Number
- Expiration Date
Date of Birth *

Month Day Year
Gender *

Female Male
Are you a U.S. Citizen? *

Yes No
Citizenship
What country are you a citizen of?
Reasons for Going on this trip *
Please describe why you're interested in serving in Nicaragua. Feel free to give a brief testimony of your faith in Christ.
Do you know your Avianca (Taca) Airlines Flight Info?

Yes No
Avianca Booking Ref Code
Typically a 6 digit code - example: 3C58V9
Avianca Ticket Number
Typically 12-13 digits - example: 2027770560104
Avianca Flight # to Managua
Example: TA451 or TA397
Departure Date

Month Day Year
FROM the US to Managua
Address *

Street Address

Street Address Line 2

City State

Zip Code
Email *
example@example.com
Mobile Phone
From time to time we send out mission trip related text messages. Don’t worry, we won’t blow up your phone with messages. You can easily opt out at any time.
T-Shirt Size *

Small Medium Large X-Large XX-Large XXX-Large XXXX-Large
Church Membership
Name of the church you attend
Occupation
Have you been with CCM before?

Yes No
Do you currently sponsor a child with CCM?
IF SO, WHAT IS THE CHILD'S NAME?
Emergency Contact Info
Emergency Contact *
First and Last Name, Relationship (ex. spouse, parent)
Relationship *
Spouse, Daughter, Son, etc...
Emergency Contact Phone Number *
Please enter a valid phone number.
Travel Accident Insurance Beneficiary
Beneficiary Same as Emergency Contact?

Yes No
Beneficiary *
First and Last Name
Relationship to Beneficiary *
Spouse, parent, etc
Medical Information
As of June 17, 2022 the Nicaraguan government updated the requirements for entry with regard to Covid Testing. If you are fully vaccinated (both doses of Moderna or Pfizer, or the single dose of Johnson & Johnson) you are NOT REQUIRED to have a Covid Test for entry. However, if you are not fully vaccinated, you must provide a Negative RT-PCR test taken no more than 72 hours prior to your arrival and submitted to CCM within 36 hours. Additionally, the U.S. government no longer requires a covid test for your return to the U.S. from Nicaragua.
Have you been fully Vaccinated for Covid-19? *

Yes No No, but I plan to
What does this mean?

You only need to show proof of Vaccination which shows you have been fully vaccinated upon entry to Nicaragua.

How can I get a new COVID-19 vaccination card?

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccination-card.html
https://vams.cdc.gov/vaccineportal/s/

If you need a new vaccination card, contact the vaccination provider site where you received your vaccine. Your provider should give you a new card with up-to-date information about the vaccinations you have received.

If the location where you received your COVID-19 vaccine is no longer operating, contact your state or local health department’s immunization information system (IIS) for assistance.

CDC does not maintain vaccination records or determine how vaccination records are used, and CDC does not provide the CDC-labeled, white COVID-19 vaccination record card to people. These cards are distributed to vaccination providers by state and local health departments. Please contact your state or local health department if you have additional questions about vaccination cards or vaccination records.
What does this mean?

You must take a RT-PCR Covid Test (NOT a rapid antigen test) after 3pm on Wednesday, Nov. 30th. If you test negative, simply print out two copies of your test results and bring to the airports in Miami and Managua.
Medical and Diet
Please list any medical issues, medications, food allergies, and diet restrictions

Code of Conduct - Please click the arrow on the right, read and acknowledge
- Seek to exhibit a servant’s attitude.
- Be flexible.
- Seek to keep an attitude that promotes unity, cooperation and respect between the team and those in leadership (team leaders/Nicaraguan leadership, etc.)
- Sleep in room you have been assigned. Always travel, eat and work as part of the group, never wandering off on your own.
- Be willing to accomplish the task assigned to your group.
- Be willing to dress by the standards which are appropriate for the culture, seeking to never be a distraction or bring offense by what you wear. Adhere to the dress code we present. No exceptions. Your signature will ensure that you have read over and will adhere to all dress code policies while on the mission field of Nicaragua with Chosen Children Ministries.
- Abstain from any conduct as requested by leaders or which you know would be offensive to others or contrary to a clear testimony for Jesus Christ. This means refraining from any use of tobacco, alcoholic beverages, offensive language or abusive drugs. Keep your conduct with the opposite sex at the highest moral standard of respect, modesty and morality as well as anything else that would negatively impact your witness or bring a bad light upon the ministry of Chosen Children.
- Show respect and understand that the doctrinal beliefs and practices of CCM will be held as the standard while serving on location. (Our doctrinal statement can be found on the website: https://www.ccm.life/believe/
- Abstain from arguments regarding politics, religion or traditions.
- Attempt to attend all team meetings, both prior to departure and during the mission trip.
- Do not seek out romantic relationships with another team member, team leader, national leaders, or translators you might meet on this trip.
- Refrain from giving gifts such as money etc. directly to CCM Staff. Although we know your intent is good there are many who serve in the background and being left out could cause unnecessary jealously among those who may not receive such gifts.
- As a short term missionary remember your responsibility to refrain from any other behavior or activity that would hinder your ministry or the ministry of your team during the term of your service.
Women and Girls:

Skirts & dresses must reach the top of the knee or longer— longer is preferred!

If wearing shorts they must reach the top of the knee or longer. No short-shorts or cheerleading shorts please.

No low necklines on women!

No belly buttons (or midriffs) showing at any time—no cropped shirts or blouses, no halter-tops

For church service we suggest skirts or dresses.

Men and Boys:

For normal work days wear pants or shorts to knee or longer with shirt or t-shirt.

No tank top shirts or cut out sleeves.

For church service you will want to wear pants and collared shirt.
Please acknowledge and click the check box *

I have read and agree to the Code of Conduct and Dress Code

END
Legal Stuff

CCM REFUND POLICY
According to IRS restrictions and ECFA Guidelines for Short-Term Mission trips, Gifts, Project Fees and LAND FEES for your trip are tax-deductible, but NON-REFUNDABLE to individual. These funds may be applied to a future trip, team project, CCM general ministry or other CCM approved project.

RECORDING POLICY
During this mission trip or event, there is a possibility that you will be filmed, recorded or photographed as part of the team or individually. By your attendance of this mission trip or ministry event, you are granting your permission to be recorded or photographed for purposes of promoting the ministry and agree to the following; being recorded, filmed or photographed by any means; or any other use of your likeness, voice and words without compensation; specifically waving all rights of privacy during the filming, recording or photographing and release Chosen Children Ministries from liability for loss, damage, or compensation from the promoting purposes or other use of your likeness, image, voice or word; compliance with all rules and regulations of Chosen Children Ministries for this mission trip or Chosen Children event of which you are a participant.

Acknowledgment, Assumption and Release
I, the undersigned, wish to participate in a short-term mission project in Nicaragua conducted under the auspices of Chosen Children Ministries (“CCM”). By signing this form, I acknowledge (1) that traveling to and in the Country of Nicaragua involves hazards not customarily encountered when traveling in America. (2) Medical facilities in Nicaragua are substandard and that should a medical emergency develop during my trip, it is unlikely that I will receive medical care in Nicaragua equivalent to that available in America. (3) Working conditions in Nicaragua are often inferior to conditions in America. (4) CCM does not carry insurance to insure against any of the risks I may encounter in Nicaragua. Despite the foregoing, it is my desire to participate in the work in Nicaragua, and I knowingly assume the risks that are involved and release CCM, its employees and agents, from any liability for injury, damage, or harm which may occur to my person or property while traveling in connection with this project or otherwise participating in this project. I affirm that I am eighteen (18) years of age or older, or the parent/guardian of the participant if under eighteen years of age, and that this Acknowledgment, Assumption, and Release is binding on me and my executor, administrators, and heirs. I give CCM and its representative (s) with me on any such trip authority to request and authorize medical and/or hospital treatment for my benefit in the event of any injury or sickness sustained by me while on such ministry activity, including, without limitation, while traveling to and from any foreign country. I agree to pay for all such treatment and to reimburse CCM for all costs and expenses incurred by it with respect to such treatment.

Covid-19 Protocol and Release of Liability
I assume all liability and risk for any injury, sickness or death that may occur from contracting or being exposed to COVID-19. I am assuming all of the risk through my voluntary participation. If I am exposed to, or if I test positive for COVID-19 while in Nicaragua, I agree that I will be solely responsible for all expenses related to, but not limited to meals, medicines, medical treatment not covered by our insurance, ground/staff transportation, flight changes or other logistic issues and compliance with COVID-19 protocol. I further agree that I will be solely responsible for the cost of all medical care and treatment and CCM will have no obligation to provide care or assistance outside of their normal scope. I agree to indemnify and hold harmless CCM from and against any losses, costs, damages and expenses resulting from contracting COVID-19 arising from participating in this project. I waive all civil liability against CMM for any injuries caused by the inherent risk associated with contracting COVID-19.
I AM: *

18 years of age and older 17 years of age and younger
18 years of age and older, please sign below

Clear
If applicant is 17 years of age and younger, please have parent or guardian sign below

Clear
Authorization to Use or Disclose Protected Health Information in the event of an emergency

Clear
Submission Date

Month Day Year
Date
Should be Empty:

Name as it appears on your passport

Emergency Contact Info

Travel Accident Insurance Beneficiary

Medical Information