Mission Trip Dates:
Recommendation: avoid making travel plans for Sunday after return. Flights are subject to change and delays and those returning from mission trip need time to rest and recover.
College Leader Fee:
(+$800 for 2-week trip)
Deposit Due with Application.
Full refund if applicant withdraws before April1, 2019Refund of fees paid less $150 if applicant withdraws before May 1, 2019No refunds after May 1.
KUC Youth Ministries does not want program cost to be a barrier to participation. Confidential scholarship requests can be made by email to Rev. Katie Lancaster email@example.com
*** Zika Virus - is active in Colombia. Please consult your physician if you are pregnant or at risk of becoming pregnant before, during or soon after travel.
Meeting with Silvi: All college leaders are required to meet with Silvi in person or over FaceTime prior to being assigned to a week.
ALL program participants are required to connect to KUC Youth leadership on social media. This includes, but is not limited to snapchat, instagram, facebook, youtube, twitter, etc.
Participants are accountable for their live and online behavior and may have to be removed from the trip roster if they exhibit conduct that glorifies or associates with drug or alcohol intoxication, illegal use of substances, criminal acts, racism, anti-semitism, bullying, online harassment, violence, sexual promiscuity or exploitation.
Permission and Liability Waiver
I have been advised about the nature of the program and consent fully to my participation in the Kenilworth Union Church IMPACT Mission Trip and associated activities. I understand the trip includes ground and air travel, lodging at a host location, traveling to different neighborhoods in and near Bogota, Colombia, and activities that may involve physical exertion such as lifting, carrying, balancing and working with tools and having contact with unsanitary conditions. Any of the included activities may pose the risk of injury, illness or death. The participant/guardian hereby release the Kenilworth Union Church and all of its agents, representatives, employees or service providers from any liability, claim, cause of action, or other expense or obligation whatsoever, that may arise out of or related to these activities.
Consent for Medical Treatment
I authorize Kenilworth Union Church adult leaders or agents to make decisions regarding medical treatment for me in the case of illness, injury, or emergency, as they deem necessary, if a family member is not present or able to be reached to make that decision. I authorize the same to dispense over-the-counter medication and first-aidto me.
I consent to the use of photographs and or videos of me during the trip and related activities (no names are used to identify minors) by Kenilworth Union Church on social media, its website, annual report and/or other church-related purposes.
Pay Now option will go to PayPal for payment once you click the submit button below. You do NOT need a Paypal account to pay. You may pay by credit card. If you do not complete the payment, you cannot return to this form. Your application will be sumbitted but held as incomplete pending payment or scholarship approval.
Make Checks Payable to:
Kenilworth Union Church
211 Kenilworth Ave
Kenilworth IL 60043
note "IMPACT Fee deposit" in the memo