STMT Required Doc's & Forms (Adult Participant)

Short Term Mission Trip Required Documents and Forms (Adult Participant)

This is Step 2 (of 2). There are 5 online "pages" to fill out. Some fields will auto-populate using your previous answers.

Required ID/Documents for these forms:
- Insurance card, Drivers License, SS#, Payment card (for $300 deposit)
Medical Information:
Full Legal Name*
Date of Birth*

MonthDayYear
Date
Insurance Company*
Main Policy Holder*
The primary insured person
Relationship of Policy Holder to Participant*
I.e., self, spouse, parent, etc.
Policy #*
Group #
Insurance Company Address*
Insurance Company Phone number*
Primary Care Physician*
Name of Physician/GNP
Primary Care Physician Address*
Primary Care Physician Phone*
Emergency Contacts:

Please provide contact information for two individuals not traveling with your team who may be contacted in the event of an emergency.
Emergency Contact 1 - Name*
Relationship to Participant*
Spouse, child, parent, friend, etc.
Phone Number*
Email*
example@example.com
Address*
Emergency Contact 2 - Name*
Relationship to Participant*
Spouse, child, parent, friend, etc.
Phone Number*
Email*
example@example.com
Address*

GCA Short-Term Mission Covenant

GCA believes that God is calling short-term missionary teams to bring the fruit of the gospel for the good of theworld. (John 15:16) GCA believes the following elements are crucial to the effectiveness, quality, and safety of ashort-term mission trip. As a member of a short-term mission team, I will agree to:

1) Remember that I am representing Jesus Christ as well as GCA. I will model Jesus in my behavior and attitude.

2) Remember that I am a guest working at my hosts' invitation. I will respect their ministry methods,realizing that ministry in other parts of the world may look different than what I am used to.

3) Commit to being a group of individuals who unite as one in purpose, striving to accomplish thesame goal of glorifying Christ and increasing His church. (1 Corinthians 12:1-31).

4) Develop and maintain a servant’s attitude toward all nationals and my teammates.

5) Commit to resolving all inter-team conflicts according to biblical principles as laid out in Matthew18:15-20. In all conflict issues, I will maintain a humble spirit of confidentially while seeking toaffirm one another in love (Ephesians 4:29; Colossians 4:6).

6) Respect my team leader and his or her decisions. In situations of team concerns, the team leaderwill be the team guide.

7) Refrain from complaining or criticizing attitude towards nationals, team leaders, and myteammates. I will strive to be creative, accommodating, and supportive in all situations to promotea positive team environment without judgment.

8) Respond without defensiveness when corrected, believing the other team members have my bestinterests and the team's interests in mind. (Proverbs 27:5-6)

9) Refrain from gossip. (Ephesians 4:29)

10) I will strive (with God’s help) to be an imitator of Christ (1 Corinthians 11:1), not causing a brotherto stumble (1 Corinthians 8:9-13), and acting in a manner appropriate to the host culture, doing allfor the glory of God. (1 Corinthians 10:31)

11) Refrain from illegal drugs and abstain from the consumption of alcoholic beverages and the use oftobacco while on the trip.

12) Refrain from the use of inappropriate or obscene language. (Ephesians 5:4, Colossians 3:8, 4:6)

13) If I am attracted to a teammate, I will not attempt to pursue a relationship until after we return home.

14) Refrain from any activity that could be constructed as a romantic interest toward a national. I realize that certain activities that seem innocent in our own culture may seem inappropriate toothers.

15) Attend all team meetings before, during, and after the trip. Team meetings are crucial foraccomplishing the trip's objectives and creating unity among the team.

16) Commit to personal quiet times by being faithful in my daily time with God. Growing individually isessential to growing as a team.

17) Commit to daily prayer, every day up to and including our time in the field, for the individuals on our team, our global partners we will serve with, and the national church.

Participant Agreement:

I agree with the GCA STM Covenant (above)

I wholeheartedly submit to the team leadership and will follow their direction and instructions.

I will, Lord willing, attend all training sessions and complete all training requirements.

I confirm that I have the time and energy to devote to the pre-, mid-, and post-trip responsibilities.

I am willing to work under the direction of missionaries and national pastors to accept and perform all assignments cheerfully and with a God-honoring attitude.

I will be flexible in my deportment, adjusting my demeanor, posture, and manner as needed.

I will agree to return home at my own expense if the team leader determines that my behavior is/ has been inappropriate.
Participant's Name
Signature*

Clear
Date

MonthDayYear
Date

Emergency Medical Release Form:
Great Commission Association Short-Term Mission Teams and their appointed team leaders have mypermission to authorize any medical treatment deemed necessary for me (or my child) by the aforementioned and the attending physician, including administration of medication, anesthesia, emergency surgery, or hospitalization. I agree to assume complete financial responsibility for all medical bills incurred by me or my child.

I agree to assume total financial responsibility to travel home immediately if it is necessary for medical or any other emergency reasons.
Name
Signature*

Clear
Date

MonthDayYear
Date
Short-Term Release of Liability (Adult)
In signing this form, I,
Name
agree not to hold Great Commission Association (GCA), its officers, employees, or other agents liable for any injury, loss, damage, or accident that I might sustain while on a short-term mission event/effort.

I realize and acknowledge that my participation in a mission trip to a foreign country includes risks and possible dangers. I understand my travel to such a foreign country exposes me to such risks as accidents, disease, war, political unrest, injury from construction projects, and other calamities.

I hereby assume any such risks that might result from my participation in any such mission project, and I unconditionally agree to hold GCA, its officers, employees, or other agents harmless for any liability concerning my personal health and wellbeing or any liability for my personal property that might be lost, damaged, or stolen while on a short-term mission trip.

I hereby expressly forever release and discharge GCA, its officers, employees, or agents from all such claims, demands, injuries, damages, or causes of action arising from any conduct on the part of GCA, its officers, agents, or employees.
Signature*

Clear
Today's Date

MonthDayYear
Date

Financial Information
Estimated Trip Costs (please fill in)*
Team Budget

Each team budget will contain several major expense categories. Examples may include airfare, vehicle- rental, housing costs, food and drink, ministry materials, gifts for hosts, and much more. Every effort is made to minimize costs without jeopardizing the quality, effectiveness, or safety of the ministry. We will work with travel agents who specialize in working with short-term mission groups. These travel agents can find discounted rates for ministry work and can provide help in working with foreign governments, international banking, passports, and visas. The travel agents also provide invaluable help in dealing with emergency changes in travel itineraries approved by the short-term trip leader.

Separate Itineraries

Separate itineraries arranged by the individual short-term participants are not allowed. Travel arrangements go much smoother if everyone has the same itinerary. Separate itineraries make planning more complicated and make it more difficult to arrange for group discounts. Separate itineraries also disrupt team bonding and unity. Exceptions may be made if a team member stays for extended ministry reasons.

Deposit Information

A $300 non-refundable deposit is required with this application. The deposit will go toward the total cost of your trip.

Payment Options:

Payment may be made online at this link. Select "GCA Missions Fund (Donations from Individuals)" from the "To:" dropdown and specify participant's name and trip location in the memo area.

Team Member Contribution

Each short-term team participant is responsible for 100% of the cost of the trip. GCA will encourage the sending church to contribute towards the short-term mission candidate from their church.
Financial Memo of Understanding

I understand that I am responsible for 100% of the funds required for the trip. The money I raise covers travel costs, food, lodging, exit taxes, ground transportation, and other ministry expenses associated with the trip.

I am responsible for passport fees, souvenirs, immunizations, prayer letters, personal meals separate from the team, and some tourist-type events. The travel agency or GCA will not be responsible for extra trip expenses (i.e., airline changes).

Financial donations made to GCA for this mission trip are not mine— they belong to God and have been given to GCA to accomplish the mission and work of the church.

If, for some reason, I do not ultimately participate in the mission trip to which I have been accepted, I am responsible for and will reimburse GCA for any fees incurred due to my cancellation (i.e., purchased airline tickets).

If, for some reason, I do not participate in the mission trip to which I have been accepted, I understand that the monies donated to my trip cannot be refunded to me or to the donors. All materials, including airline and other travel tickets that have been purchased with donated funds, cannot be transferred outside of the trip.

I understand if I do not meet the funding deadlines, I may not be allowed to go on the mission trip. Any money raised will not be refunded but will be applied to the current trip or other mission ministries.

If I raise an amount of money that exceeds my needs, the remaining money will be dispersed to other team members in need or used by GCA to assist the mission partners.

I will agree to return home at my own expense if the team leadership determines that my behavior is /has been inappropriate, and none of the money raised will be refunded to me or any donors.

I have read and agree to the above policies, rules, and terms.
Participant’s name
Signature*

Clear
Date Signed

MonthDayYear
Date

Authorization & Request for Criminal Records Check
I,
Name of Participant
hereby authorize GCA to conduct a background screen by any entity chosen by GCA specifically for conducting this search to release information regarding any record of charges or convictions in any criminal file maintained on me, whether said file is a local, state, or national file, and including but not limited to accusations and convictions for crimes committed against minors, to the fullest extent permitted by state and federal law. I do release GCA and other entities from all liability resulting from any such disclosure made in response to this request.
Signature*

Clear
Date

MonthDayYear
Date
Print all other names that have been used by applicant (if any, including maiden name)
Date of Birth

MonthDayYear
Date
Social Security Number*
Street Address*
City/State/Zip*
Phone Number*
Driver’s License*
State*
Should be Empty: