MISSION TRIP REGISTRATION FORM

MISSION TRIP REGISTRATION FORM

Complete and submit form together with a clear copy of your passport (s) to: Missions Department, Christ Methodist Church. Attention: Edwin Seah
Passport must be valid for minimum 6 months from the date of travelling.

Parental consent is required from applicants under the age of 21 years.

All Registration Forms are for official use and will be kept strictly Confidential.

TRIP CODE

Bintan (Indonesia)

Cambodia

Thailand

West Kalimantan

Indonesia

IB 2: 7/8 Feb
IB 4: 11 – 12 Apr
IB 5: 9 – 10 May
IB 7: 11 – 12 Jul
IB 9: 12 – 13 Sep
IB 11: 14 – 15 Nov
IB 12: 12 – 13 Dec

Krang Svay

KSMC:

9 - 13 Dec

Thanyaburi

TKPMC

9 - 14 Dec

Phitsanulok

ASK 1:

10-15 June

ASK 2:

18-23 Nov

TBC

TRIP TRAINING DATES - PRE TRIP TRAINING IS COMPULSARY
Trip Code:*
Date of Mission Trip (From)*

DayMonthYear
Date
Date of Mission Trip (Until)*

DayMonthYear
Date
I. PERSONAL PARTICULARS
Title*
Mr / Mrs / Ms / Miss
Name as in Passport *
Age:*
Nationality:*
Gender*
Date of Birth*

DayMonthYear
Date
Passport No:*
Passport Date of Issue:*

DayMonthYear
Date
Passport Date of Expiry:*

DayMonthYear
Date
Please upload Participant Passport Details Image / Screenshot your Passport Details Images*

Cancelof
Passport validation must at least 6 months.
NRIC / FIN NO:*
Home / Office / Mobile Contact No:*
Email*
example@example.com
Occupation*
Address*
Blood Group:*
Preferred Hotel Room Type during the Mission Trips. (Room Type depends on the availability from the hotel/Guest house).*

Single RoomTwin SharingTriple SharingConnecting Room
With Who?*
With Who?*

ParentsGrandparentsChildrenFamily / RelativesFriend / Others
II. EMERGENCY INFORMATION
In case of emergency, contact:*
Relationship:*
Address:*
Home / Office / Mobile Contact No:*

III. COST OF TRIP AND SUBSIDY

COUNTRY	ESTIMATE COST ($) OF THE TRIP
CAMBODIA	700.00
THAILAND	800.00
BINTAN, INDONESIA	180.00

Request for Subsidy ($)*

YesNo
Which Country?*

RECOMMENDATION FOR SUBSIDY REQUEST

(To be filled in by church leader or pastor for applicants who are not CMC members)
A. Why would you recommend the applicant for this trip?*
B. Leader / Pastor Name:*
C. Care Group / Ministry:*
A) Full payment must be made upon submission of the registration form.

B) Cheque paid to CHRIST METHODIST CHURCH, please indicate the Mission Trip and date of trip behind the cheque.

C) A PDF copy will be emailed upon registration for church leader or pastor to sign.

IV. MEDICAL STATEMENT
State your present health:*
Known medical problems or allergies:*
* Mission Committee will request for a medical certificate for ability to travel.

VII. TERM AND CONDITION
i. Pre-Trip Preparation

Applicants are required to attend all Pre-Trip Briefing / Training sessions. CMC reserve the right to stop applicants from embarking on the trip should they fail to attend all the sessions required. Applicants shall bear full responsibility for all 3rd party fee that may be incurred.

ii. Payment and Cancellation Payments *

Participants are required to place payment upon registration.
A forfeiture payment of $200 plus third-party charges incurred is imposed withdrawal, unless on medical grounds (to be certified by attending doctor) and family emergency matters.

iii. Flight

All prices quoted are estimates. Actual prices may go up or down depending on actual price upon booking. Flight tickets may be limited due to peak season. All participants will be accepted on first-come, first-serve basis.

iv. Visa

Trippers are to obtain their own personal Visa to the country. A copy of the approval visa is to be submitted to the church office.

v. Approval of Applicants

The church reserves the right not to accept participants whom the church considers unsuitable to go on the mission trip.

vi. Subsidy

1. The Applicant must be a CHURCH MEMBER or a CHILD OF CHURCH MEMBER to be eligible for a subsidy application

- An Applicant who is not a church member (including those below 18 yrs old) but has been attending CMC for at least 6 months, and considers CMC their home church can also be eligible for a trip subsidy if:

a) The Applicant is recommended by their care group Leader or ministry leader.

b) If the Applicant is not in any care group or serving in ministry, they will need to get a pastor or church leader who knows them to recommend them.

2. The Applicant must also fulfil the following FINANCIAL CRITERIA to be eligible for a subsidy:

- Children, student and the unemployed are eligible for up to 50% subsidy.

- If currently employed,

a) Applicant with per capita income below $1,250 can apply for up to 50% subsidy.

b) Applicant with per capita income below $2,500 can apply for up to 25% subsidy.

c) Applicant must provide proof of income (Eg. copy of payslip, CPF statement etc) and household size (Eg. copy of household members' NRIC)

3. Approval of subsidy is subjected to the final review and decision the Missions Committee.

VIII. DECLARATION
FOR APPLICANT*

I declare all information disclosed in this applicant form and its attachments to be true and correct. I have not withheld and relevant information.In the event of any discrepancy in the information provided, I will bear responsibility for any fee amendment or additional cost that should arise.
Signature

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FOR PARENT / GUARDIAN (Applicant below 21 years old)*

I understand and agree to the term and conditions mentioned. I accept full responsibility for allowing my ward to go on this trip.
Parent / Legal Guardian's Name*
Parent / Legal Guardian's Contact No.*
Signature*

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PERSONAL DATA CONSENT CLAUSE*

By submitting my Child's / my ward personal data on this application form for CMC mission trip for the period, I agree and consent to Christ Methodist Church collecting, using, disclosing and sharing amongst the relevant parties and / or ministries my personal data, for the purpose of engagement and operational planning of this mission trip. I also consent to the Church contacting me by telephone or sending text or email messages to me in relation to my application to go for this mission trip.
LIABILITY AGREEMENT*

I do hereby release Christ Methodist Church, its agent, staff and volunteer assistants from any liability whatsoever arising out of any injury, damage or lass which may be sustained by me / my child / ward during the course of the mission trips.
Signature*

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MISSION TRIP REGISTRATION FORM

I. PERSONAL PARTICULARS

II. EMERGENCY INFORMATION

III. COST OF TRIP AND SUBSIDY

IV. MEDICAL STATEMENT

V. CHURCH RELATED INFO

VI. INSURANCE

VII. TERM AND CONDITION

VIII. DECLARATION